实时剪切波弹性成像及超声造影技术评估慢性肾病临床分期的价值

The value of real-time shear wave elastography and contrast-enhanced ultrasound in the evaluation of clinical stages of chronic kidney disease

目的探讨实时剪切波弹性成像(SWE)及超声造影(CEUS)技术评估不同分期慢性肾脏疾病(CKD)中肾实质的弹性及肾皮质血流灌注改变的临床价值。方法选取我院收治的109例CKD患者(CKD组)和20例健康志愿者(对照组)。分别进行肾SWE、CEUS检查,获得肾实质弹性参数:最大值(Emax)、最小值(Emin)、平均值(Emean)、标准差(SD)和肾皮质血流灌注参数:曲线上升支斜率(A)、曲线下降支斜率(α)、曲线下面积(AUC)、峰值强度(PI)、达峰时间(TTP)。观察CKD组和对照组以及不同分期CKD患者上述参数的差异。结果CKD组Emax、Emean、SD、AUC、TTP、A均高于对照组,差异有统计学意义(P<0.05),Emin、PI低于对照组,差异有统计学意义(P<0.05)。不同CKD分期SWE参数比较发现:CKD 4~5期组患者Emax、Emean、SD、AUC、TTP、A均高于CKD 1~3期组,差异有统计学意义(P<0.05),Emin、PI低于CKD 1~3期组,差异有统计学意义(P<0.05)。不同CKD分期肾皮质血流灌注参数比较发现CKD 4~5期组患者AUC、TTP、A均高于CKD 1~3期组,差异有统计学意义(P<0.05),PI低于CKD 1~3期组,差异有统计学意义(P<0.05)。Emean(r=0.968,P<0.001)、Emax(r=0.870,P<0.001)、Emin(r=0.827,P<0.001)与CKD分期之间呈显著正相关。ROC曲线分析可以得出:以Emean=2.735 kPa作为诊断对照组与CKD组的临界值,AUC为0.955(95%CI:0.921~0.988),灵敏度为89.7%、特异度为91.3%;以Emax=5.565 kPa作为临界值,AUC为0.920(95%CI:0.856~0.916),灵敏度为78.1%、特异度为97.1%;以Emin=1.16 kPa作为临界值,AUC为0.94(95%CI:0.902~0.974)其灵敏度为79.0%、特异度为91.9%。结论SWE、CEUS对CKD患者不同分期肾实质弹性和肾皮质血流灌注具有较高的评估价值。

Objective To explore the clinical application value of real-time shear wave elastography(SWE)technology combined with contrast-enhanced ultrasound(CEUS)to evaluate renal cortical blood perfusion and renal parenchymal elasticity in different stages of chronic kidney disease.Methods 109 CKD patients(CKD group)and 20 healthy volunteers(control group)were selected.The renal parenchymal elastic parameters(Emax,Emin,emean,SD)and renal cortical perfusion parameters(A,α,AUC,PI and peak)were obtained by SWE and CEUS examination Time(TTP).The above parameters of CKD group and control group were observed.Results Emax,Emean,SD,AUC,TTP,and A in the CKD group were higher than those in the control group(P<0.05),and Emin and PI were lower than those in the control group(P<0.05).Comparison of SWE parameters in different CKD stages revealed that Emax,Emean,SD,AUC,TTP,and A were higher in patients with stage CKD 4~5 than those in stage CKD 1~3(P<0.05),and Emin and PI were lower than those in stage CKD 1~3(P<0.05).The comparison of renal cortical blood perfusion parameters in different CKD stages revealed that the AUC,TTP,and A of the patients in the CKD 4~5 stage were higher than those in the CKD 1~3 stage(P<0.05),and the PI was lower than that in the CKD 1~3 stage(P<0.05).There was a significant negative correlation between the Young's modulus of elasticity(r=-0.681,P<0.001)and CKD stage;Emean(r=0.968,P<0.001),Emax(r=0870,P<0.001),Emin(r=0.827,P<0.001)and CKD stage were significantly positively correlated.ROC curve analysis can be obtained:Emean=2.735 kP a was used as the cutoff value for diagnosis of normal group and CKD group,AUC was 0.955(95%CI:0.921~0.988),sensitivity was 89.7%,specificity was 91.3%;With Emax=5.565 kP aI s the critical value,AUC was 0.920(95%CI:0.856~0.916),sensitivity was78.1%,specificity was 97.1%;Emin=1.16 kP a as the critical value,AUC was 0.940(95%CI:0.902~0.974).The sensitivity was 79.0%and the specificity was 91.9%.Conclusion SWE and CEUS have high appraisal value for different stages of renal parenchymal elasticity and renal cortical blood perfusion in patients with CKD.