超微血流成像联合声脉冲辐射力弹性成像对IgA肾病的诊断价值

Value of superb microvascular imaging combined with aoustic radiation force impulse in diagnosis of IgA nephropathy

目的评估超微血流成像(SMI)联合声脉冲辐射力弹性成像(ARFI)对IgA肾病(IgAN)的诊断价值。方法选择2019年5月至2021年3月河南科技大学第一附属医院收治的经肾组织病理学检查确诊的124例IgAN患者为研究对象(IgAN组);选择本院同期同年龄段肾脏大小及肾功能相关检查无异常的35例体检者为对照组。通过病历及体检资料获取2组受试者的体质量指数(BMI)、血压信息。采用SMI技术测量2组受试者肾脏叶间动脉的阻力指数(RI),对肾内血流灌注程度进行量化评估;采用ARFI技术测量肾实质的剪切波速度(SWV),量化分析肾实质的弹性状况。绘制受试者操作特征(ROC)曲线,计算曲线下面积(AUC),评估ARFI、SMI单独及联合应用对IgAN的诊断效能。结果IgAN组患者的BMI、收缩压、舒张压与对照组比较差异无统计学意义(P>0.05)。IgAN组患者的RI显著高于对照组(P<0.05),SWV显著低于对照组(P<0.05)。应用SMI技术测量RI诊断IgAN的截断值为0.60,AUC为0.795(P=0.000,95%置信区间:0.724~0.870),其诊断IgAN的灵敏度为58.1%,特异度为85.7%,约登指数为0.44;应用ARFI技术测量SWV诊断IgAN的截断值为2.26 m·s^(-1),AUC为0.858(P=0.000,95%置信区间:0.803~0.915),其诊断IgAN的灵敏度为74.2%,特异度为88.6%,约登指数为0.63。2种技术联合(RI≥0.60或SWV≤2.26 m·s^(-1)时)诊断IgAN的AUC为0.878(P=0.000,95%置信区间:0.824~0.932),其诊断IgAN的敏感度为83.1%,特异度为91.4%,约登指数为0.75。应用ARFI技术测量SWV对IgAN的诊断效能优于应用SMI技术测量RI对IgAN的诊断效能,但二者比较差异无统计学意义(Z=1.473,P>0.05)。应用ARFI技术测量SWV联合应用SMI技术测量RI对IgAN的诊断效能优于单独应用SMI技术测量RI对IgAN的诊断效能(Z=2.429,P<0.05);应用ARFI技术测量SWV联合应用SMI技术测量RI对IgAN的诊断效能优于单独应用ARFI技术测量SWV对IgAN的诊断效能,但二者比较差异无统计学意义(Z=1.269,P>0.05)。结论SMI及ARFI联合检测可通过量化分析肾脏血流灌注及肾实质质地状况,为IgAN的早期诊断、干预提供客观证据。

Objective To evaluate the diagnostic value of superb microvascular imaging(SMI)combined with aoustic radiation force impulse(ARFI)for IgA nephropathy(IgAN).Methods A total of 124 patients with IgAN diagnosed by renal histopathology in the First Affiliated Hospital of Henan University of Science and Technology from May 2019 to March 2021 were selected as the research subjects(IgAN group).In addition,35 healthy check-ups of the same age with the IgAN patients who had normal renal size and renal function were selected as the control group.The body mass index(BMI)and blood pressure of subjects in the two groups were obtained through medical records and physical examination data.The resistance index(RI)of renal interlobar artery of all subjects was measured by SMI,and the degree of renal blood perfusion was quantitatively evaluated.The shear wave velocity(SWV)of renal parenchyma was measured by ARFI technique,and the elasticity of renal parenchyma was quantitatively analyzed.The receiver operating characteristic(ROC)curve was drawn,and the area under curve(AUC)was calculated to evaluate the diagnostic efficacy of ARFI and SMI alone and the combination of ARFI and SMI for IgAN.Results There was no significant difference in BMI,systolic blood pressure and diastolic blood pressure of subjects between the IgAN group and the control group(P>0.05).The RI of patients in the IgAN group was significantly higher than that in the control group(P<0.05),and the SWV was significantly lower than that in the control group(P<0.05).The cut-off value of RI measured by SMI in the diagnosis of IgAN was 0.60,the AUC was 0.795(P=0.000,95% confidence interval was 0.724-0.870),the sensitivity was 58.1%,the specificity was 85.7%,and the Youden index was 0.44.The cut-off value of SWV measured by ARFI was 2.26 m·s^(-1),the AUC was 0.858(P=0.000,95% confidence interval was 0.803-0.915),the sensitivity was 74.2%,the specificity was 88.6%,and the Youden index was 0.63.The AUC of the combined detection of RI and SWV(RI≥0.60,SWV≤2.26 m·s^(-1))in diagnosis of IgAN was 0.878,the sensitivity was 83.1%,the specificity was 91.4%,and the Youden index was 0.75.The diagnostic efficacy of SWV measured by ARFI was better than that of RI measured by SMI,but the difference was not statistically significant(Z=1.473,P>0.05).The diagnostic efficacy of RI measured by SMI combined with SWV measured by ARFI for IgAN was better than that of RI measured by SMI(Z=2.429,P<0.05).The diagnostic efficacy of RI measured by SMI combined with SWV measured by ARFI for IgAN was better than that of SWV measured by ARFI,but the difference was not statistically significant(Z=1.269,P>0.05).Conclusion The combined detection of SMI and ARFI can provide the objective evidence for early diagnosis and intervention for IgAN through quantitative analysis of renal blood perfusion and texture.