超声造影定量参数鉴别诊断移植肾急性排异和急性肾小管坏死的临床价值  

Quantitative analysis of contrast-enhanced ultrasonography in differentiating acute rejection from acute tubular necrosis of transplant kidney

作　　者：何婉媛[1] 周盛[1] 杨橙[1] 金赟杰[1] 季正标[1] 王文平[1] 

机构地区：[1]上海市影像医学研究所,复旦大学附属中山医院超声科,上海市器官移植重点实验室,200032

出　　处：《中华超声影像学杂志》2014年第11期952-956,共5页Chinese Journal of Ultrasonography

基　　金：上海市自然科学基金（13ZR1406400）

摘　　要：目的探讨超声造影定量参数在鉴别诊断移植肾急性排异反应中的临床价值。方法移植肾患者67例，其中正常组30例，急性排异组（AR）26例，急性肾小管坏死组（ATN）11例，常规超声测量移植肾段间动脉收缩期峰值流速（PSV）和阻力指数（RI），超声造影结合时间一强度曲线定量分析叶间动脉、皮质和髓质的上升时间（RT）、达峰时间（TTP）、平均通过时间（mTT））以及皮质和髓质之间的上升时间差（△RTm-c）和达峰时间差（△TTPm-c），采用组内相关系数评价各造影定量参数的稳定性。结果与正常组比较，AR组的RI明显增高（P〈0．05），但AR组的RI与ATN组比较差异无统计学意义（P〉0．05），观察者内超声造影参数RT和TTP的稳定性较好（ICC〉0．75），急性排异组髓质的RT、TTP以及ARTm-c和△TTPm-C较ATN和正常组明显延长（P〈0．05）。ROC曲线分析显示5种参数诊断急性排异的准确性依次为ARTm-c〉△TTPm-c〉RTm〉TTPm〉RI（曲线下面积分别为0．786、0．756、0．749、0．736、0．498），ARTm-c≥4．62s为截断值具有最高的诊断价值（敏感性和特异性分别为78．3％和73．5％）。结论超声造影定量参数可客观地反映移植肾不同状态的血流灌注，与常规超声比较，能更好地鉴别诊断移植肾急性排异。Objective To evaluate the value of quantitative analysis of contrast-enhanced ultrasonography （CEUS） in differentiating acute rejection （AR） from acute tubular necrosis （ATN） of transplant kidney.Methods Total of 67 kidney recipients were examined with conventional US and CEUS. Biopsies were performed in 37 patients, 26 patients were with AR, 11 with ATN, 30 patients as control group.The hemodynamie parameters （PSV and RI） were measured on infrarenal artery with conventional US,while CEUS quantitative analysis was performed on the cortex, pyramid and interlobar artery by time- intensity curve （TIC）.TIC parameters including rise time （RT）, time to peak （TTP）, mean transit time （mTT） were compared among three groups. In addition, the reproducibility of TIC parameters was evaluated.Results The RI in AR group was significantly higher than that in control group,but there were no significant differences of RI between AR and ATN groups.TIC parameters including RT,TTP were with high reproducibility （ICC〉0.75）.Compared to the other two groups, the RT and TTP of the pyramid, △RTm-c, and △TTPm-c were significantly longer in AR group, the receiver operating curves （ROC） analysis demonstrated that △RTm-c had the highest accuracy and RI had the lowest accuracy for detecting AR（areas under the curve were 0.786,0.756,0.749, 0.736 and 0.498, respectively）. High sensitivity and specificity（78.3% and 73.5% ,respectively） were shown when using 4.62 s as a cutoff point of ARTm-c to diagnose AR.Conclusions Quantitative analysis of CEUS could detected the changes of the microcirculation perfusion in kidney grafts with AR and ATN,which might be superior in the diagnosis of AR compared with conventional US.

关 键 词：超声检查 微气泡 肾移植 移植物排斥 肾小管坏死 急性 

分 类 号：R699.2[医药卫生—泌尿科学]