超声造影分析肾功能不全移植肾不同皮质的异常灌注  

Analysis of the characteristics of microcirculatory perfusion changes between different cortexes of renal dysfunction in transplanters with contrast-enhanced ultrasound

作　　者：高峰[1] 李凡[1] 刘阳[1] 李朝军[1] 乔晓慧[1] 李春晓[1] 杜联芳[1] 邢晋放[1] 

机构地区：[1]上海交通大学附属上海市第一人民医院超声科,上海市200080

出　　处：《临床超声医学杂志》2016年第10期653-656,共4页Journal of Clinical Ultrasound in Medicine

基　　金：国家自然科学基金(81471666)

摘　　要：目的分别对移植肾包膜下皮质和近髓皮质的超声造影图进行定量分析,探讨其对检测肾功能不全移植肾皮质微循环灌注改变的临床价值。方法 74例同种异体移植肾患者,肾移植术后6个月至27年。按照连续3个月肾小球滤过率(eGFR)水平分为3组:肾功能正常组32例[e GFR≥90 ml/(min·1.73 m^2)],肾功能轻度下降组19例[e GFR60~90 ml/(min·1.73 m^2)],肾功能中度下降组23例[eGFR 30~60 ml/(min·1.73 m^2)]。常规超声检查后行超声造影,选择移植肾中部包膜下皮质(包膜下3 mm肾皮质区)、近髓皮质(弓形动脉上方3 mm肾皮质区)和全层皮质(包络整个皮质区)作为感兴趣区,通过时间-强度曲线测定参数:到达时间(AT)、上升时间(RT)、绝对达峰时间(ATTP)及平均渡越时间(MTT)。结果与肾功能正常组比较,肾功能轻度下降组包膜下皮质RT、ATTP均升高(均P<0.05),肾功能中度下降组AT、RT、ATTP、MTT均升高(均P<0.05);肾功能中度下降组近髓皮质和全层皮质的AT、RT、ATTP、MTT均升高(均P<0.05)。结论分别分析包膜下皮质和近髓皮质的方法较分析全层皮质方法,能够更早检测到肾功能不全微循环灌注的异常,可以更加全面地评价肾皮质微循环灌注特征。Objective To investigate the clinical value of contrast-enhanced ultrasound（CEUS）in diagnosis of early kidney graft dysfunction by detecting the subcapsular and juxtamedullary cortical microcirculatory perfusion. Methods A total of74 patients after 6 months to 27 years of kidney transplantation were divided into three groups according to the levels of glomerular filtration rate（e GFR）in consecutive 3 months： the normal renal function group[e GFR≥90 ml/（min·1.73 m^2）]in 32 cases, the mild reduction group[e GFR 60~90 ml/（min·1.73 m^2）]in 19 cases and the moderate reduction group[e GFR 30~60 ml/（min·1.73 m^2）]in23 cases. Contrast-enhanced ultrasonography was performed after conventional ultrasonography. The subcapsular cortex（3 mm renal cortical area under the capsular）, juxtamedullary cortex（3 mm renal cortical area above the arch artery）and the entire cortex（including the entire cortex）in the middle of renal transplants were selected as the regions of interest（ROI）, then the timeintensity curve（TIC） and some quantitative parameters were obtained,which including arrival time（AT）, rise time（RT）,absolute peak time（ATTP） and mean transit time（MTT）. Results Compared with renal function in normal group,the RT and ATTP in the subcapsular cortex in mild reduction group increased significantly（P0.05）, the AT, RT, ATTP and MTT in moderate group increased significantly（P0.05）,the AT, RT, ATTP and MTT in the juxtamedullary cortex and the entire cortex in moderate reduction group increased significantly（P0.05）. Conclusion Comparison of analysis the entire cortex, the subcapsular cortex and juxtamedullary cortex can detect the microcirculation perfusion abnormalities of renal dysfunction earlier, and can more fully evaluate the renal cortex microcirculation perfusion characteristics.

关 键 词：超声检查 造影剂 移植肾 肾皮质 

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