彩色多普勒超声结合背向散射积分诊断多发性骨髓瘤肾损伤  

The value of color Doppler and integrated backscatter ultrasound in the diagnosis of renal impairment of multiple myeloma

作　　者：张锐[1] 宋苏云[1] 王丰[1] 陈刚[1] 张雪珍[1] 肖芳[1] 

机构地区：[1]怀化市第一人民医院超声科,湖南省418000

出　　处：《中华临床医师杂志（电子版）》2012年第21期6757-6760,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：怀化市科技局科技计划项目(2011-9-2)

摘　　要：目的利用彩色多普勒超声结合背向散射积分技术评价多发性骨髓瘤(MM)患者肾脏改变。方法对于71例MM患者及20例对照组进行彩色多普勒超声和背向散射积分检查评价肾脏改变,计算超声检测指标与检验指标的相关性,并建立多因素Logistic回归模型预测患者有无肾损伤。结果 MM肾损伤组皮质IBS%值、髓质IBS%值、叶间动脉阻力指数(RI)高于对照组及MM无肾损伤组,叶间动脉收缩期最大流速(PSV)低于对照组及MM无肾损伤组,MM肾损伤组肾脏长度及体积均小于MM无肾损伤组(P均<0.05)。MM患者皮质IBS%值、髓质IBS%值和叶间动脉RI与血肌酐、尿素氮、尿酸和β2微球蛋白呈正相关(P均<0.05),叶间动脉PSV与上述指标呈负相关(P均<0.05)。进入Logistic回归模型因素为肾脏体积、髓质IBS%、叶间动脉PSV和叶间动脉RI,回归模型准确度为91.5%(65/71)、敏感度80.8%(21/26)、特异度97.8%(44/45)。结论 MM肾损伤组肾脏长度及体积较小,皮质及髓质IBS%值增高,叶间动脉PSV减低、RI增高,皮质及髓质IBS%值和叶间动脉PSV及RI与检验指标相关性良好,利用回归模型可以较好地预测MM患者有无肾损伤。Objective To investigate color Doppler and integrated backscatter ultrasound characteristics of multiple myeloma with renal impairment.Methods Seventy-one multiple myeloma patients and twenty controls underwent renal color Doppler and integrated backscatter ultrasound exam,and the relationship between the ultrasound characteristics and renal function markers were calculated.Logistic regression analysis was used for judge between with and without renal impairment.Results Multiple myeloma patients with renal impairment showed a higher IBS% of cortex and medulla,and resistive index of interlobar renal artery than patients without renal impairment and controls,lower peak systolic velocity was found in patients with renal impairment.Patients with renal impairment showed a smaller renal length and volume(all P<0.05).IBS% of cortex and medulla,the resistive index and peak systolic velocity of interlobar renal artery were associated with serum creatinine,urea nitrogen,uric acid and beta-2-microglobulin(all P<0.05).Finally four ultrasound characteristics were applied into the logistic regression model as volume of renal,IBS% of medulla and the resistive index and peak systolic velocity of interlobar renal artery,the accuracy,sensitivity,and specificity of the model were 91.5%,80.8%,97.8%.Conclusions Multiple myeloma patients with renal impairment show a smaller length and volume of renal,higher IBS% of cortex and medulla,lower peak systolic velocity and increased resistive index of interlobar renal artery.IBS% of cortex and medulla,the resistive index and peak systolic velocity of interlobar renal artery are associated with renal function markers.Logistic regression model can be useful for predicting renal impairment in multiple myeloma patients.

关 键 词：多发性骨髓瘤 超声检查 多普勒 彩色 肾损伤 背向散射积分 

分 类 号：R445.1[医药卫生—影像医学与核医学] R733.3[医药卫生—诊断学]