超声造影参数与IgA肾病病理相关性的研究

Correlation between contrast-enhanced ultrasound parameters and pathology of IgA nephropathy

目的探讨超声造影(CEUS)参数与IgA肾病病理改变的相关性。方法前瞻性纳入行肾脏穿刺活检及同侧肾脏CEUS检查的IgA肾病病人50例,男27例,女23例,平均(40.20±13.65)岁。使用SonoLiver定量分析软件进行图像后处理,获得相关定量参数,包括上升时间(RT)、达峰时间(TTP)、峰值强度(Imax)、曲线下面积(AUC)和曲线上升支斜率(A)等。采用Katafuchi半定量积分法对组织学标本中的肾小球、肾小管/间质、肾血管病变程度评分。将CEUS参数与病理评分进行Spearman秩相关分析。结果Imax值与球性硬化积分、肾小球总积分、间质炎细胞浸润积分、间质纤维化积分、肾小管萎缩积分及肾小管/间质总积分、血管壁增厚积分、透明样变性积分及肾血管总积分、病理总积分均呈负相关(均P<0.05)。此外,RT、TTP与透明样变性积分呈正相关(r=0.353、0.418,P=0.012、0.003),AUC值与血管壁增厚积分、肾血管总积分呈负相关(r=-0.379、-0.365,P=0.007、0.009)。A值与透明样变性积分和肾血管总积分呈负相关(r=-0.464、-0.356,P=0.001、0.011)。结论部分CEUS参数与IgA肾病病理改变具有一定的相关性,有助于无创监测肾脏的病理进展。

Objective To investigate the correlation between contrast-enhanced ultrasound(CEUS)parameter and pathological changes of IgA nephropathy.Methods Fifty patients with IgA nephropathy who underwent renal biopsy and ipsilateral kidney CEUS examination were prospectively included,including 27 males and 23 females,with an average of 40.20±13.65 years old.The SonoLiver quantitative analysis software was used to post-process the contrast images to obtain the relevant quantitative parameters,including rise time(RT),time to peak(TTP),maximum intensity(Imax),area under the curve(AUC)and slope of ascending time(A),etc.Katafuchi semi quantitative integral method was used to score the degree of glomerulus,renal tubule/interstitium and renal vascular lesions in histological specimens.Spearman rank correlation analysis was performed between CEUS parameters and pathological scores.Results The Imax was negatively correlated with the glomerular sclerosis score,total glomerular score,interstitial inflammatory cell infiltration score,interstitial fibrosis score,tubular atrophy score,tubular/interstitial score,vascular wall thickening score,hyaline degeneration score,total renal vascular score,and total pathological score(all P<0.05).In addition,the RT and TTP were positively correlated with hyaline degeneration scores(r=0.353 and 0.418,P=0.012 and 0.003,respectively),and the AUC was negatively correlated with vascular wall thickening scores and total renal vascular scores(r=-0.379 and-0.365,P=0.007 and 0.009,respectively).The A value was negatively correlated with the hyaline degeneration score and total renal vascular score(r=-0.464 and-0.356,P=0.001 and 0.011,respectively).Conclusion Some CEUS parameters are correlated with the pathological changes of IgA nephropathy,which is helpful for noninvasive monitoring of renal pathological progress.