摘要
目的利用超声造影(CEUS)定量分析比较移植肾微循环灌注的特征及其差异。方法肾移植术后不同肾功能受者分成3组:肾功能稳定组33例、经穿刺病理证实的急性排斥反应(AR)组27例和慢性排斥反应(CR)组14例。采用超声造影定量分析软件脱机分析超声造影图像资料,获取移植肾皮、髓质内感兴趣区的灌注参数。比较肾功能稳定组、AR组及CR组之间灌注参数的差异,并评价彩色多普勒超声与超声造影在诊断移植肾慢性排斥反应中的临床价值。结果彩色多普勒参数阻力指数(RI)在肾功能稳定组、AR组与CR组之间差异无统计学意义(P>0.05);与肾功能稳定组相比,CR组的皮质达峰强度(Pic)、髓质达峰强度(PIm)、皮质上升斜率(a3c)、髓质上升斜率(a3m)及皮质曲线下面积(AUCc)明显降低,而皮质平均渡越时间(MTTc)及髓质平均渡越时间(MTTm)明显延长(P<0.05);肾功能稳定组与AR组间除a3m、PIc及PIm外,其余参数在两组间差异均无统计学意义(P<0.05);与AR组相比,CR组的MTTc及MTTm明显延长,髓质曲线下面积(AUCm)及PIm明显减低(P<0.05)。当PIm<26.7 dB时,对CR的诊断效能最高,其敏感性与特异性分别为85.7%与72.7%。结论相较于彩色多普勒超声,超声造影可以更好地评价移植肾微循环血流灌注,为临床诊断慢性排斥反应提供一定辅助参考价值。
Objective To explore the characteristics and differences of micro-perfusion between patients after transplant kidney with stable renal function,acute rejection and chronic rejection by contrast-enhanced ultrasound(CEUS)quantifying.Methods Thirty-three patients with stable renal function,27 patients with acute rejection and 14 patients with chronic rejection were enrolled.The perfusion parameters of region of interest in renal cortex and medulla were obtained by CEUS offline data quantitative analysis software.The perfusion parameters in stable renal function group were compared with those in acute rejection and chronic rejection groups;furthermore,the value of color Doppler and CEUS in the diagnosis of chronic rejection was explored and compared.Results As for resistance index RI on color Doppler,it made no statistical difference among three groups(P>0.05).The perfusion parameters derived from CEUS quantitative analysis and Color Doppler parameter resistance index(RI)were not statistically different among renal function stabilization,acute rejection and chronic rejection groups(P>0.05);as compared with stable renal function group,there were marked reductions in peak intensity of cortex(Pic),peak intensity of medulla(PIm),ascending slope of cortex(a3c)ascending slope of medulla(a3m)and area under the curve of cortex(AUCc)in chronic rejection group.And mean transit time of cortex(MTTc)and mean transit time of medulla(MTTm)became significantly prolonged(P<0.05).Except for a3m,Pic and PIm were not significantly different between stable renal function and acute rejection groups(P>0.05).As compared with acute rejection group,MTTc and MTTm were significantly prolonged in chronic rejection group while AUCm and PIm declined markedly(P<0.05).When PImV26.7dB,the diagnostic efficiency of chronic rejection was the highest and the sensitivity and specificity were 85.7%and 72.7%respectively.Conclusions As compared with color Doppler,CEUS quantitative parameters based on S-G filter theory can evaluate the micro-perfusion of transplant kidney more precisely and may provide diagnostic clue for chronic rejection.
作者
赵智锦
杨萍
季正标
何婉媛
王文平
hao Zhijin;Yang Ping;Ji Zhengbiao;He Wanyuan;Wang Wenping(Department of Ultrasonography,Zhongshan Hospital,Fudan University,Shanghai Institute of Imaging Medicine,Shanghai 200032,China)
出处
《中华器官移植杂志》
CAS
北大核心
2019年第4期215-218,共4页
Chinese Journal of Organ Transplantation
基金
上海市科委医学引导类项目(15411964900)
上海市医学领军人才项目(2015-卫计委-25).
关键词
肾移植
超声造影
排斥反应
Kidney transplantation
Ultrasound contrast
Rejection
