实时剪切波弹性成像在尿蛋白阳性慢性肾脏病患儿中的应用

Application of real-time shear-wave elastography in children with uroprotein-positive chronic kidney disease

目的:比较不同程度尿蛋白阳性慢性肾脏病(Chronic kidney disease,CKD)患儿不同程度肾纤维化的肾皮质杨氏模量值的差异,以探讨实时剪切波弹性成像定量评估在尿蛋白阳性CKD患儿中的应用价值。方法:采用实时剪切波弹性成像技术分别测量60名健康儿童(对照组)与68例尿蛋白阳性CKD患儿(CKD组)肾皮质杨氏模量值,CKD组患儿行肾组织活检及染色确定肾纤维化程度。结果:健康儿童与尿蛋白阳性CKD患儿的肾皮质杨氏模量值有差异(P<0.01),健康儿童杨氏模量值为(3.67±0.46)kPa。CKD组中轻度肾纤维化30例,杨氏模量值为(6.36±0.53)kPa,尿蛋白2+占73%;中度肾纤维化20例,杨氏模量值为(7.56±0.25)kPa,尿蛋白2+占15%,尿蛋白3+占70%;重度肾纤维化8例,杨氏模量值为(8.01±0.61)kPa,尿蛋白2+占25%,尿蛋白3+占50%,尿蛋白4+占25%。结论:蛋白尿阳性CKD组患儿肾皮质杨氏模量值大于健康儿童肾皮质杨氏模量值,且杨氏模量值随肾纤维化程度的加重有增高的趋势。尿蛋白2+及以上和杨氏模量值在6及以上的患儿不排除肾间质纤维化,实时剪切波弹性成像定量评估可能为尿蛋白阳性CKD患儿提供二维超声检查以外的诊断信息。

Objective:To compare the difference of Young’s modulus of renal cortex in children with different degrees of urinary protein-positive chronic kidney disease(CKD)with different degrees of renal fibrosis,and to explore the application value of shear-wave elastic imaging in quantitative evaluation of children with chronic kidney disease.Methods:Real-time shear-wave elastography was used to calculate the Young’s modulus of renal cortex in 60 healthy children and 68 children with urinary protein-positive CKD,respectively.Renal tissue biopsy and staining were performed in CKD group to confirm the degree of renal fibrosis.Results:The Young’s modulus of renal cortex was different between healthy subjects and children with urinary protein-positive CKD(P<0.01).The Young’s modulus of renal cortex was(3.67±0.46)kPa in healthy children.In CKD group,thirty cases had mild renal fiber with Young’s modulus value of(6.36±0.53)kPa and urinary protein 2+of about 73%.Twenty cases of moderate renal fibrosis,with Young’s modulus value of(7.56±0.25)kPa and urinary protein 2+of 15%plus urinary protein 3+of 70%.Eight cases of severe renal fibrosis,with Young’s modulus value of(8.01±0.61)kPa and urinary protein 2+of about 25%plus urinary protein 3+of about 50%,urinary protein 4+of about 25%.Conclusion:The Young’s modulus of renal cortex in CKD patients with proteinuria was greater than that in healthy subjects,and Young’s modulus tended to increase with the aggravation of renal fibrosis degree.The children with urinary protein 2+or above and Young’s modulus 6 or above cannot exclude renal interstitial fibrosis.Quantitative evaluation of real-time shear-wave elastography may provide diagnostic information beyond two-dimensional ultrasound for children with urinary-protein-positive CKD.