E成像定量技术对IgA肾脏病患者经皮超声引导下肾脏活检后血肿的预测价值

The predictive value of Shear Wave Elastography for hematoma after renal biopsy guided by percutaneous ultrasound in patients with IgA nephropathy

目的探讨基于E成像定量技术(SWE)的肾实质杨氏模量均值及相关因素对经皮肾实质活检(PRB)的IgA肾病患者肾实质血肿的预测价值。方法分析比较经病理证实的90例IgA肾病患者的相关超声图像特征。将IgA肾病患者分为PRB术后有血肿和无血肿两组,分析两组患者在实验室检查、灰阶超声检查和EMean实质方面的差异。采用受试者工作特征曲线(ROC)评价EMean实质对肾实质活检血肿的预测价值。采用Logistic回归分析,以年龄、性别及EMean实质为影响因素,寻找PRB术后肾脏血肿发生的危险因素。采用spearman相关性分析对PRB术后血肿大小的相关性因素进行分析。结果90例IgA肾脏病患者中,PRB术后血肿68例(75.6%),无血肿22例(24.4%)。两组患者的年龄、性别、血红蛋白、血肌酐、尿素氮、肾小球滤过率、肾脏深度、肾脏长度、肾脏宽度、肾实质厚度以及慢性肾脏病(CKD)分期差异无统计学意义(P>0.05)。与无血肿的患者相比,术后血肿患者的EMean实质显著增高(4.70kPa VS.9.80 kPa),差异有统计学意义(P<0.001)。ROC曲线分析表明,EMean实质对PRB术后肾脏血肿有良好的预测价值,曲线下面积(AUC)为0.878,当EMean实质最佳截断值为6.20 kPa时,灵敏度为77.3%,特异性为94.1%。Logistic回归分析显示,EMean实质是PRB术后血肿的独立危险因素。此外,肾实质厚度与肾穿后血肿大小呈负相关关系,而EMean实质与肾穿后血肿大小呈正相关关系,相关系数分别为-0.292(P=0.016)、0.669(P<0.0001)。结论基于E成像定量技术得到的EMean实质对IgA肾病患者经皮肾实质活检的血肿发生有良好的预测效能。

Objective To investigate the predictive value of the young's modulus value of renal parenchyma and related factors based on shear wave elastography(SWE)for renal parenchyma hematoma in IgA patients with renal disease by percutaneous renal parenchyma biopsy(PRB).Methods The ultrasonographic characteristic of 90 cases of IgA renal disease confirmed by pathology were analyzed and compared.Patients with IgA renal disease were divided into two groups according to hematoma after PRB,and the differences of laboratory examination,gray scale ultrasonography and mean of young's modulus of renal parenchyma between the two groups were analyzed.Receiver operating characteristic curve(ROC)was used to evaluate the predictive value of young's modulus for hematoma after renal parenchymal biopsy.Age,gender and EMean parenchyma were taken as influencing factors.Logistic regression analysis was used to find the risk factors of renal hematoma after PRB.Spearman correlation analysis method was used to analyze the related factors of hematoma size after PRB.Results Among 90 IgA patients,68 cases(75.6%)had hematoma after PRB,and 22 cases(24.4%)had no hematoma.There were no significant differences in age,gender,hemoglobin value,serum creatinine value,urea nitrogen value,glomerular filtration rate,depth of the kidney,kidney length,kidney width,renal parenchymal thickness and chronic kidney disease(CKD)stage between the 2 groups(P>0.05).Compared to the patients without hematoma(4.70 kPa),patients with hematoma(9.80 kPa)had significantly higher EMean of renal parenchyma(P<0.001).The analysis of ROC curve showed that EMean parenchyma had a good predictive value for renal hematoma after PRB.The area under the curve(AUC)was 0.878,the optimal cutoff value of EMean parenchyma was 6.20 kPa,the sensitivity was 77.3%,and the specificity was 94.1%.Logistic regression analysis showed that EMean was an independent risk factor for postoperative hematoma of PRB.In addition,the thickness of renal parenchyma was negatively correlated with the size of hematoma(-0.292,P=0.016)and EMean parenchyma was positively correlated with the size of hematoma(0.669,P<0.0001).Conclusion EMean parenchyma based on SWE has a good predictive effect on the hematoma after percutaneous ultrasound-guided renal biopsy in patients with IgA kidney disease.