超声造影定量评价不同生存期移植肾血流灌注的临床价值

Clinical value of quantitative contrast-enhanced ultrasound in evaluation of blood perfusion of transplanted kidney at different survival stages

目的分析超声造影时间-强度曲线(CEUS-TIC)评估移植肾血流灌注状态与移植肾生存率之间的相关性。方法选取南京大学附属金陵医院(东部战区总医院)2011年1月至2020年12月行肾移植术患者共186例。根据患者移植肾的随访存活时间分为A组:1~12个月;B组:13~60个月;C组:61~120个月;D组:>120个月。所有患者行常规超声及CEUS检查。采用单因素方差分析/χ^(2)检验比较不同分组患者基本临床资料,肾功能,二维超声及多普勒血流显像参数,CEUS-TIC参数包括皮质开始增强时间(AT)、达峰时间(TTP)以及达峰强度(PI)之间的差异。采用有序多分类Logistic回归分析具有统计学意义的参数评估移植肾生存率的相关因素。结果A~D组患者分别为59例、45例、41例、41例。单因素分析结果表明,A~D组患者收缩压[(138.41±12.58)mmHg vs(141.23±14.48)mmHg vs(134.25±9.31)mmHg vs(134.63±12.53)mmHg]、舒张压[(87.03±7.58)mmHg vs(84.78±8.90)mmHg vs(81.94±8.93)mmHg vs(84.26±8.96)mmHg]、移植后是否存在并发症[是/否:25/34 vs 24/21 vs 24/29 vs 9/32]、血肌酐浓度[(233.34±183.65)μmol/L vs(376.51±257.71)μmol/L vs(455.56±268.41)μmol/L vs(635.20±515.47)μmol/L]、估计的肾小球滤过率(eGFR)水平[(95.88±18.19)ml/(min·L)vs(85.65±17.43)ml/(min·L)vs(66.95±20.55)ml/(min·L)vs(52.12±26.62)ml/(min·L)]、超声测量肾脏厚度[(61.09±12.89)mm vs(67.12±11.06)mm vs(66.42±11.16)mm vs(67.83±10.02)mm]、弓形动脉阻力指数(RI)[(0.60±0.15)vs(0.62±0.09)vs(0.65±0.12)vs(0.67±0.09)]、PI[(34.41±7.89)dB vs(31.81±7.61)dB vs(28.32±4.61)dB vs(23.96±4.83)dB]差异具有统计学意义(F=3.109,P=0.028;F=2.939,P=0.035;χ^(2)=14.862,P=0.021;F=13.370,P<0.001;F=42.020,P<0.001;F=3.806,P=0.011;F=2.793,P=0.042;F=10.458,P<0.001)。有序多分类Logistic回归模型结果显示,PI(OR=11.302,95%CI:4.711~27.086,P<0.001)、肌酐(OR=0.278,95%CI:0.141~0.550,P<0.001)、并发症(OR=0.275,95%CI:0.124~0.609,P<0.001)以及eGFR(OR=6.449,95%CI:3.267~12.743,P<0.001)均与患者移植肾生存预后独立相关。结论CEUS-TIC是评估不同生存时间移植肾血流灌注的有效手段,CEUS-TIC参数PI评估移植肾血流灌注状态与移植肾生存率之间的相关性最强。

Objective To investigate the correlation between the blood perfusion status of the transplanted kidney evaluated by contrast-enhanced ultrasound with time-intensity curve(CEUS-TIC)and the survival rate of the transplanted kidney.Methods A total of 186 kidney transplantation patients were selected from General Hospital of Eastern Theater Command from January 2011 to December 2020.According to the follow-up survival time of the patients with kidney transplantation,they were divided into four groups:A(1-12 months);B(13-60 months);C(61 to 120 months);and D(>120 months).All patients underwent conventional ultrasound and CEUS examination.ANOVA/Chi-square test was used to compare the differences in age,renal function,ultrasonic Doppler flow parameters,and CEUS-TIC parameters including cortical arrival time(AT),peak arrival time(TTP),and peak intensity(PI)among different groups.The variables statistically significant associated with survival rate were further assessed by ordered multiple Logistic regression analysis.Results There were 59,45,41,and 41 patients in groups A to D,respectively.Univariate analysis showed that there were significant differences in systolic blood pressure[(138.41±12.58)mmHg vs(141.23±14.48)mmHg vs(134.25±9.31)mmHg vs(134.63±12.53)mmHg;F=3.109,P=0.028],diastolic blood pressure[(87.03±7.58)mmHg vs(84.78±8.90)mmHg vs(81.94±8.93)mmHg vs(84.26±8.96)mmHg;F=2.939,P=0.035],post-transplant complications[yes/no:25/34 vs 24/21 vs 24/29 vs 9/32;χ^(2)=14.862,P=0.021],serum creatinine concentration[(233.34±183.65)μmol/L vs(376.51±257.71)μmol/L vs(455.56±268.41)μmol/L vs(635.20±515.47)μmol/L;F=13.370,P<0.001],estimated glomerular filtration rate(eGFR)[(95.88±18.19)ml/(min·L)vs(85.65±17.43)ml/(min·L)vs(66.95±20.55)ml/(min·L)vs(52.12±26.62)ml/(min·L);F=42.020,P<0.001],ultrasonically measured renal thickness[(61.09±12.89)mm vs(67.12±11.06)mm vs(66.42±11.16)mm vs(67.83±10.02)mm;F=3.806,P=0.011],arcuate artery RI[(0.60±0.15)vs(0.62±0.09)vs(0.65±0.12)vs(0.67±0.09);F=2.793,P=0.042],and PI[(34.41±7.89)dB vs(31.81±7.61)dB vs(28.32±4.61)dB vs(23.96±4.83)dB;F=10.458,P<0.001]among patients with different survival periods.Ordered multiple Logistic regression analysis showed that PI(OR=11.302,95%CI:4.711-27.086,P<0.001),creatinine(OR=0.278,95%CI:0.141-0.550,P<0.001),post-transplant complications(OR=0.275,95%CI:0.124-0.609,P<0.001),and eGFR(OR=6.449,95%CI:3.267-12.743,P<0.001)were independently associated with survival prognosis.Conclusion CEUS-TIC is an effective method to evaluate the blood perfusion of the transplanted kidney at different survival times,and it can provide effective information for the clinical status of transplanted kidney function.PI shows the strongest correlation between graft perfusion status and graft survival rate.