超声造影定量分析对移植肾排斥反应的诊断价值  

Quantitative Analysis of Contrast-enhanced Ultrasonography in Diagnosis of Kidney Transplantation Rejection

作　　者：张华[1] 梁伟翔[1] 余江秀[1] 严宝妹[1] 

机构地区：[1]广州医科大学附属第三医院超声医学科,广东广州510150

出　　处：《中国医学影像学杂志》2014年第9期678-680,685,共4页Chinese Journal of Medical Imaging

摘　　要：目的通过超声造影成像技术定量分析移植肾术后急性和慢性排斥反应血流灌注参数的特征,为临床快速评估移植肾排斥反应的预后提供参考价值。资料与方法 31例行同种异体肾移植患者依据临床症状及移植肾穿刺结果分为移植肾正常组6例、急性排斥组12例和慢性排斥组13例,应用超声造影成像检查移植肾的血流灌注情况。结果超声造影显示无排斥反应患者移植肾实质造影剂增强均匀,而有排斥反应患者移植肾实质增强不均匀;3组移植肾造影剂曲线下面积差异有统计学意义(F=37.102,P<0.01),移植肾正常组达峰强度显著高于急性排斥组(P<0.01),但与慢性排斥组无显著差异。急性排斥组和慢性排斥组叶间动脉、皮质和髓质的造影剂起始时间、叶间动脉和皮质的造影剂达峰时间均晚于移植肾正常组(P<0.05),急性排斥组和慢性排斥组段间动脉、叶间动脉和皮质的绝对强度、叶间动脉和皮质的上升斜率均显著小于移植肾正常组(P<0.05)。结论超声造影能较好地评价移植肾的微循环状态,可以为预测肾移植术后急性和慢性排斥反应提供重要的参考价值。Purpose To quantitatively analyze the blood perfusion parameters alter kidney transplantation with acute and chronic rejection by using contrast-enhanced ultrasonography （CEUS）, in order to provide rapid assessment for rejection prognosis. Materials and Methods Thirty-one patients with kidney transplantation were followed up and divided into three groups according to clinical symptoms and graft biopsy results： normal group （n=6）, acute rejection group （n-12） and chronic rejection group （n=13）. CEUS was carried out to assess renal microcirculation perfusion. Results CEUS showed that the normal renal parenchyma was enhanced homogeneously whilst the rejected parenchyma was enhanced heterogeneously. The differences of area under the curve among the three groups was statistically significant （F=37.102, P〈0.01）, with normal group 〉chronic rejection group 〉 acute rejection group. The peak intensity in normal group was higher than that in acute rejection group （P〈0.01）, but it showed no difference with that in chronic group. In acute and chronic rejection groups, the arrival time and the time to peak intensity in interlobar artery and cortex were all later than those in normal group （P〈0.05）. The ascending slope of TIC in segmental artery, interlobar artery and cortex in the two rejection groups was both significantly less than that in normal group. Conclusion CEUS is a valuable diagnostic tool in the evaluation of microcirculation perlhsion in kidney grail, and can provide important reference for the prognosis of acute and chronic rejection after kidney transplantation.

关 键 词：肾移植 移植物排斥 超声检查 多普勒 彩色 超声造影 局部血流 

分 类 号：R692.5[医药卫生—泌尿科学] R445.1[医药卫生—外科学]