托拉塞米联合葡萄糖快速利尿后超声技术诊断在役飞行员肾微小结石的临床价值

Clinical value of torasemide combined with 50%glucose rapid diuretic ultrasonography in the diagnosis of renal microcalculi in pilot service

目的探讨托拉塞米联合50%(质量分数)葡萄糖快速利尿实验技术诊断飞行人员肾微小结石的临床价值。方法对常规超声怀疑肾微小结石和肾钙化灶的189例在役飞行人员行托拉塞米联合50%(质量分数)葡萄糖快速利尿后超声检查,以输尿管软镜检查结果为金标准进行对比观察,判断利尿超声检查肾微小结石的准确性。结果189例飞行人员,常规超声诊断肾微小结石160例176枚,钙化灶10例20枚,不能明确诊断19例19枚;利尿后超声诊断肾微小结石155例307枚,钙化灶34例45枚。诊断肾微小结石者均进行药物排石或激光碎石,半年后复查,20例90枚结石消失,其余169例飞行人员入院接受输尿管软镜手术,发现肾盏内结石139例210枚,肾钙化灶30例52枚。常规超声与利尿后超声对肾微小结石的诊断差异有统计学意义(P<0.001);常规超声与输尿管软镜检查对肾微小结石的诊断差异有统计学意义(P=0.026),常规超声诊断肾脏微小结石的敏感度为58.7%,特异度为75.0%。利尿后超声与输尿管软镜检查对肾微小结石的诊断差异无统计学意义(P=0.874),利尿后超声诊断肾脏微小结石敏感度为97.7%,特异度为86.5%。结论托拉塞米联合50%葡萄糖快速利尿后超声技术可以显著提高肾脏微小结石的诊断效率,可作为在役飞行人员肾脏微小结石早期诊断的首选方式。

Objective To investigate the clinical value of tolasemide combined with 50%glucose rapid diuretic ultrasound test in the diagnosis of renal microcalculi in flight crew.Methods A total of 189 flight crew in service suspected of renal microcalculi and renal calcification by conventional ultrasonography were examined by tolasemide combined with 50%glucose rapid diuretic ultrasonography.Comparing the results of flexible ureteroscopy as the gold standard,to evaluate the accuracy of diuretic ultrasonography in renal microcalculus.Results Among 189 pilots,160 cases of renal microcalculi were diagnosed by conventional ultrasound(176 calculi),10 cases of calcification(20 calcification foci),19 cases of undefinable diagnosis(19 strong echo points).155 cases of renal microcalculi(307 calculi)and 34 cases of calcification(45 calcification foci)were diagnosed after diuretic ultrasonography.All the patients diagnosed with renal microcalculi underwent medical lithotripsy or laser lithotripsy.Half a year later,90 calculi in 20 cases disappeared,and the remaining 169 flight crew were admitted to the hospital for flexible ureteroscopic surgery.210 calculi in 139 cases and 52 calcification foci in 30 cases were found.There was a statistical difference between conventional ultrasound and post-diuretic ultrasound examination in the diagnosis of renal microcalculi(P<0.001);there was a statistical difference between conventional ultrasound and flexible ureteroscopy in the diagnosis of renal microcalculi(P=0.026),the sensitivity and specificity of conventional ultrasonography in the diagnosis of renal microcalculi were 58.7%and 75.0%.There was no statistically significant difference between post-diuretic ultrasound examination and flexible ureteroscope examination of renal microcalculi(P=0.874),the sensitivity and specificity of post-diuretic ultrasound in the diagnosis of renal microcalculi were 97.7%and 86.5%.Conclusion Torasemide combined with 50%glucose rapid post-diuretic ultrasound can significantly improve the diagnostic efficiency of renal microcalculi,and it can be used as the preferred method for early diagnosis and treatment of renal microcalculi in flight service.