肾病综合征剪切波弹性成像与病理分型的关系

The relationship between shear wave elastography and pathological classification in nephrotic syndrome

目的探索剪切波弹性成像在肾病综合征诊断与病理分型中的临床价值。方法回顾性分析2022年6月至2023年3月在重庆医科大学附属永川医院经肾穿刺活检确诊为原发性肾病综合征患者43例(原发性肾病综合征组)的临床资料,并进一步分为系膜增生性肾小球肾炎组、膜性肾病组、微小病变肾病组三个亚组,另选30例健康体检者为对照组。应用剪切波弹性成像测量右肾下极实质剪切波速度,统计分析各组之间剪切波速度差异。结果原发性肾病综合征组剪切波速度[(1.76±0.41)m/s]与对照组[(1.55±0.34)m/s]差异有统计学意义(P<0.05);其中膜性肾病组剪切波速度[(1.97±0.36)m/s]最高,与微小病变肾病组[(1.54±0.42)m/s]比较差异有统计学意义(P<0.05);膜性肾病组与系膜增生性肾小球肾炎组[(1.74±0.38)m/s]、系膜增生性肾小球肾炎组与微小病变肾病组剪切波速度比较差异均无统计学意义(均P>0.05)。结论剪切波弹性成像是一种无创性检查,通过检测肾脏的剪切波速度,可为肾病综合征诊断与病理分型提供一定价值的临床线索。

Objective To explore the clinical value of shear wave elastography in the diagnosis and pathological classification of nephrotic syndrome.Methods A retrospective analysis was conducted on the clinical data of 43 patients with primary nephrotic syndrome(primary nephrotic syndrome group)diagnosed through renal biopsy at the Yongchuan Hospital Affiliated to Chongqing Medical University from June 2022 to March 2023.They were further divided into three subgroups:mesangial proliferative glomerulonephritis group,membranous nephropathy group,and minimal change nephropathy group.Another 30 healthy individuals were selected as the control group.We applied shear wave elastography to measure the shear wave velocity of the right renal lower pole parenchyma and statistically analyzed the differences in shear wave velocity between each group.Results There was a statistically significant difference in shear wave velocity between the primary nephrotic syndrome group[(1.76±0.41)m/s]and the control group[(1.55±0.34)m/s](P<0.05);The shear wave velocity in the membranous nephropathy group[(1.97±0.36)m/s]was the highest,and there was a statistically significant difference(P<0.05)compared to the small lesion nephropathy group[(1.54±0.42)m/s];There was no statistically significant difference in shear wave velocity between the membranous nephropathy group and the mesangial proliferative glomerulonephritis group[(1.74±0.38)m/s],as well as between the mesangial proliferative glomerulonephritis group and the small lesion nephropathy group(all P>0.05).Conclusions Shear wave elastography is a non-invasive examination that provides valuable clinical clues for the diagnosis and pathological classification of nephrotic syndrome by detecting the shear wave velocity of the kidney.