超微血流成像与CDFI在慢性肾脏病肾血流灌注中的应用

Application of superb micro-vascular imaging and CDFI in renal blood perfusion of chronic kidney disease

目的探讨超微血流成像(SMI)与彩色多普勒超声(CDFI)在评价慢性肾脏病(CKD)患者肾血流灌注改变中的临床应用价值。方法收集2020年3月~2021年1月于自贡市第一人民医院临床确诊的CKD患者73例(146个肾)以及同期在我院进行体检的正常体检者34例(68个肾)作为研究对象。根据慢性肾脏病K/DOQI分期指南,将73例CKD设为病例组,病例组患者分为CKD1期组、CKD2期组、CKD3期组、CKD4期组、CKD5期组5组,将34例正常体检者设为对照组。分别于CDFI及SMI模式下观察所有研究对象双侧肾脏血流灌注情况,并对CDFI及SMI肾血流灌注进行分级、记录。结果在214个肾脏中,SMI显示为4~5级157个(73.4%),显示为0~3级57个(26.6%);CDFI显示为4~5级118个(55.1%),显示为0~3级96个(44.9%);同一组别SMI与CDFI肾血流灌注分级构成比进行比较,各组差异均有统计学意义(P<0.05),且对照组、CKD1~CKD3期组SMI显示4~5级的构成比均高于CDFI(P<0.05);CKD4期组、CKD5期组SMI显示3~4级的构成比均高于CDFI(P<0.05)。6组CDFI肾血流灌注分级两两比较:对照组与CKD1期组、CKD2期组,CKD1期组与CKD2期组、CKD3期组,CKD2期组与CKD3期组,CKD3期组与CKD4期组,CKD4期组与CKD5期组比较,差异均无统计学意义(P>0.05),余组两两对比,差异有统计学意义(P<0.05)。6组SMI肾血流灌注分级两两比较:对照组与CKD1期组、CKD2期组,CKD1期组与CKD2期组,CKD3期组与CKD4期组比较,差异均无统计学意义(P>0.05),余组两两对比,差异有统计学意义(P<0.05)。结论SMI对CKD不同临床分期肾血管的显示能力优于CDFI,且能够较早检测出CKD肾血流灌注的改变,有助于CKD的临床诊断、病情评估及治疗,可以作为评价CKD肾血流灌注改变的有效检查手段,具有重要临床应用价值。

Objective To explore the clinical value of super microvascular imaging(SMI)and CDFI in evaluating renal perfusion changes in patients with chronic kidney disease(CKD).Methods Seventy-three patients with CKD(146 kidneys)diagnosed at our hospital from March 2020 to January 2021 and thirty-four normal physical examinees(68 kidneys)who performed physical examination in our hospital at the same term were collected as study subjects.According to the K/DOQI staging criteria of CKD,seventy-three patients with CKD were divided into CKD stage 1 group,CKD stage 2 group,CKD stage 3 group,CKD stage 4 group and CKD stage 5 group,a total of 5 groups were set up as case groups,and 34 normal subjects were set up as control groups.CDFI and SMI techniques were used to observe the bilateral renal blood perfusion of all subjects,respectively,and the blood perfusion was graded and recorded.Results Among 214 kidneys,SMI showed grade 4~5 in 157(73.4%)and grade 0~3 in 57(26.6%);CDFI showed grade 4~5 in 118(55.1%)and grade 0~3 in 96(44.9%);The composition ratio of SMI and CDFI renal blood perfusion grading in the same group was compared,and the differences were statistically significant(P<0.05),and the composition ratio of SMI showing grade 4~5 in the control group and CKD1 stage group~CKD3 stage group was higher than that of CDFI.The composition ratio of SMI grade 3~4 was higher than CDFI in CKD4 stage group and CKD5 stage group.Two-by-two comparison of CDFI renal blood perfusion grading in 6 groups:no statistically significant difference(P>0.05)between control group and CKD1 stage group and CKD2 stage group,CKD1 stage group and CKD2 stage group and CKD3 stage group,CKD2 stage group and CKD3 stage group,CKD3 stage group and CKD4 stage group,CKD4 stage group and CKD5 stage group,and the rest two-by-two comparison,the difference was statistically significant(P<0.05).Pairwise comparison of renal blood perfusion grades detected by SMI in 6 groups:there were no statistically significant difference(P>0.05)between control group and CKD1 stage group and CKD2 stage group,CKD1 stage group and CKD2 stage group,CKD3 stage group and CKD4 stage group,and the rest two-by-two comparison,the difference was statistically significant(P<0.05).Conclusion The ability of SMI to display renal vessels in different clinical stages of CKD is better than that of CDFI,and it can detect the alteration of renal blood perfusion in CKD at an earlier stage,which is helpful for the clinical diagnosis,disease assessment and treatment of CKD,and can be used as a routine and effective means to evaluate the alteration of renal perfusion in CKD,and has important clinical application value.