彩色多普勒感兴趣区定量技术评价慢性肾脏病患者肾脏末梢血流灌注的临床价值

Clinical value of region of interest quantification technique in evaluating renal peripheral inflow perfusion in patients with chronic kidney disease by color Doppler

目的探讨彩色多普勒感兴趣区定量技术评价慢性肾脏病(CKD)患者肾脏末梢循环血流灌注的临床应用价值。方法收集我院收治的180例CKD患者,按照《肾活检组织慢性化病变的标准化分级推荐》分为轻微病变组69例、轻度慢性病变组65例、中至重度慢性病变组46例;另选同期年龄、性别与之匹配的健康体检者120例为对照组。记录各组基线资料和实验室生化指标;采集右肾二维及彩色血流动态图像,测量肾脏长径、实质厚度、小叶间动脉收缩期峰值流速(PSV)和阻力指数(RI);应用QLAB软件自动分析感兴趣区内肾脏末梢血流灌注指标,包括血管指数(VI)、血流指数(FI)、血管血流指数(VFI)。比较各组上述参数的差异,应用多因素Logistic回归分析CKD发生的危险因素,并分析肾脏末梢血流灌注指标在不同观察者、不同感兴趣区勾画部位时测值的一致性。结果①各组在性别、年龄、身高、体质量、体质量指数、空腹血糖、甘油三酯、总胆固醇比较,差异均无统计学意义;在血肌酐、尿素氮、尿酸、白蛋白、尿红细胞计数、合并高危疾病方面比较,差异均有统计学意义(均P<0.01)。②随着慢性化病变程度的加重,轻微病变组、轻度慢性病变组和中至重度慢性病变组的VI、FI、VFI逐渐降低,均显著低于对照组,差异均有统计学意义(均P<0.01)。③多因素Logistic回归分析显示,年龄、VFI、白蛋白、尿红细胞计数是预测CKD发生的危险因素。④一致性分析显示,VI、FI、VFI在不同观察者、不同感兴趣区勾画部位的测值均有较好的一致性。结论彩色多普勒感兴趣区定量技术可早期、动态地监测CKD患者肾脏末梢血流灌注改变,对评估肾脏损害及慢性化病变进展程度有一定的临床意义。

Objective To explore the clinical application value of region of interest quantification technique in evaluating renal peripheral inflow perfusion in patients with chronic kidney disease(CKD)by color Doppler.Methods A total of 180 patients with CKD in our hospital were selected and divided into minimal chronic changes group(69 cases),mild chronic changes group(65 cases),and moderate-severe chronic changes group(46 cases)according to“A proposal for standardized grading of chronic changes in native kidney biopsy specimens”.120 healthy individuals with matched age and gender during the same period were selected as the control group.Baseline data,laboratory biochemical indexes in each group were recorded.Two dimensional image and color Dopper blood flow dynamic images of the right kidney were acquired.The length and parenchymal thickness of the kidney,peak systolic velocity(PSV)and resistance index(RI)of interlobular artery were measured.Vascularization index(VI),flow index(FI),vascularization flow index(VFI)were analyzed by region of interest quantification at QLAB work station.The differences of the above parameters in each group were compared,and multivariate Logistic regression was used to analyze the risk factors of CKD,and the consistency of renal peripheral inflow perfusion indexes in different observers and different regions of interest were analyzed.Results①There were no significant differences in gender,age,height,weight,body mass index,fasting blood glucose,triglyceride and total cholesterol among the groups,while there were statistically differences in serum creatinine,blood urea nitrogen,uric acid,albumin,urine red blood cell count and combined high-risk diseases(all P<0.01).②With the aggravation of chronicity,the VI,FI and VFI of minimal,mild and moderate-severe chronic changes group were decreased,and lower than those of the control group,the differences were statistically significant(all P<0.01).③Multivariate Logistic regression analysis showed that age,VFI,albumin and urine red blood count were risk factors for CKD.④Bland-Altman analysis showed that there were good consistency in the measurement of VI,FI and VFI between different observers and different regions of interest.Conclusion Region of interest quantification technique by color Doppler can early and dynamically monitor the changes of renal peripheral inflow perfusion in CKD patients,so as to quantitatively analyze the progress of renal damage and chronic changes.