声脉冲辐射力弹性成像评价慢性肾小球肾炎的病理特征  

Acoustic Radiation Force Impulse Imaging for the Assessment of Renal Histopathology in Chronic Glomerulonephritis

作　　者：胡巧[1] 王小燕[1] 康利克[1] 韦海明[2] 贺红光[3] 贺琰[1] 

机构地区：[1]广西壮族自治区人民医院超声科,广西南宁530021 [2]广西壮族自治区人民医院病理科,广西南宁530021 [3]广西壮族自治区人民医院肾内科,广西南宁530021

出　　处：《中国医学影像学杂志》2015年第4期302-305,共4页Chinese Journal of Medical Imaging

基　　金：国家自然科学基金项目(81260223);广西自然科学基金项目(2012GXNSFBA053083)

摘　　要：目的应用声脉冲辐射弹性成像(ARFI)观察慢性肾小球肾炎(CGN)患者肾实质弹性变化,探讨ARFI评价CGN病理损害的价值。资料与方法 123例CGN患者依据肾穿刺活检病理评分分为轻度、中度及重度损害组,并选择27例健康志愿者作为对照组。比较受试者肾实质剪切波传播速度(SWV)变化,分析SWV测值与肾纤维化Katafuchi评分、血肌酐及肾小球滤过率(e-GFR)的相关性,构建ROC曲线确定ARFI评价CGN病理损害程度的价值。结果各组CGN患者与对照组比较,SWV测值差异有统计学意义(F=16.592,P<0.01);重度损害组SWV低于轻度、中度损害组及对照组(P<0.001);SWV与肾纤维化Katafuchi评分、血肌酐呈负相关(r=-0.481、-0.441,P<0.01),与e-GFR呈正相关(r=0.546,P<0.01);以2.65 m/s、2.50 m/s和2.34 m/s为界值诊断轻度、中度、重度肾损害的敏感度分别为63.4%、71.4%和93.8%,特异度分别为77.8%、71.3%和79.9%,ROC曲线下面积分别为0.730、0.738和0.870。结论 ARFI技术有望成为一种有效的无创性定量评价CGN肾纤维化的方法。Purpose To observe the change of renal parenchyma elasticity in patients with chronic glomerulonephritis （CGN）, and to explore the value of acoustic radiation force impulse （ARFI） in the assessment of renal histological damages in CGN. Materials and Methods 123 patients with CGN and 27 healthy volunteers were enrolled, CGN patients were divided into three groups according to renal histologic scores： mildly, moderately, and severely impaired. Shear wave velocities （SWV） of the renal parenchyma were measured and compared in different groups, the correlation between the SWV measurements and renal fibrosis Katafuchi scores, serum creatinine （Scr） and estimated glomerular filtration rate （e-GFR） was accessed, and receiver operating characteristic （ROC） curves analyses were also performed to assess the value of ARFI for the diagnosis of pathology impairment degree in CGN. Results There were statistically significant differences in SWV measurements between each CGN patient group and the control group （F=16.592, P＆lt;0.01）; the mean SWV in patients with severe kidney impairment was significant lower than that of mildly impaired, moderately impaired, and the control groups （P＆lt;0.001）. SWV measurements correlated significantly with renal fibrosis Katafuchi scores （r=-0.481, P＆lt;0.01）, Scr （r=-0.441, P＆lt;0.01）, and e-GFR （r=0.546, P＆lt;0.01）; ROC analyses indicated that the sensitivity was 63.4%, 71.4%, 93.8%, specificity was 77.8%, 71.3%, 79.9%, and the area under the curve was 0.730, 0.738 and 0.870, when using the optimal cut-off value of 2.65 m/s for the diagnosis of mildly impaired kidneys, 2.50 m/s for moderately impaired kidneys, and 2.34 m/s for severely impaired kidneys, respectively. Conclusion ARFI is expected to become an effective tool for non-invasive evaluating of renal histological fibrosis in CGN patients.

关 键 词：肾小球肾炎 慢性病 超声检查 多普勒 彩色 弹性成像技术 病理学 外科 

分 类 号：R543.5[医药卫生—心血管疾病] R445.2[医药卫生—内科学]