声辐射力脉冲弹性成像技术在中老年急慢性肾病患者中的应用价值  

The application value of elastography technology of acoustic radiation force impulse in elderly patients with acute or chronic kidney disease

作　　者：李立红[1] 朱立松[2] 武敬平[3] 杨琳[3] 刘健[3] 牟姗[4] 郑敏[3] Li Lihong;Zhu Lisong;Wu Jingping;Yang Lin;Liu Jian;Mou Shan;Zheng Min(Department of Acupuncture and Moxibustion;Department of Ultrasonography,Zhejiang Provincial People′s Hospital,Hangzhou 310014,China;Department of Ultrasonography,China-Japan Friendship Hospital,Beijing 100029,China;Department of Nephrology,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]浙江省人民医院针灸科,杭州310014 [2]浙江省人民医院超声科,杭州310014 [3]中日友好医院超声诊断科,北京100029 [4]上海交通大学医学院附属仁济医院肾内科,200025

出　　处：《中华医学超声杂志（电子版）》2017年第6期462-467,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：港澳台科技合作专项(2014DFT30090)

摘　　要：目的探讨声辐射力脉冲弹性成像(ARFI)技术检测剪切波速度(SWV)鉴别诊断中老年急性肾损伤(AKI)与慢性肾病(CKD)患者的应用价值。方法选择2015年2月至2016年12月中日友好医院及浙江省人民医院收治的中老年肾病患者64例(肾病组)。其中CKD患者43例(CKD组),AKI患者21例(AKI组,合并CKD15例,不合并CKD6例)。选择同期中日友好医院29名体检健康的中老年志愿者(健康对照组)。采用ARFI技术测量所有受检者肾脏中部SWV值。采用方差分析比较健康对照组受检者、AKI组、CKD组患者肾脏长径、肾皮质厚度、肾皮质SWV值,进一步组间两两比较采用LSD-t检验。采用方差分析比较健康对照组受检者、不合并及合并CKD的AKI组、CKD组患者肾皮质SWV值,进一步组间两两比较采用LSD-t检验。绘制ARFI技术诊断肾病的操作者工作特性(ROC)曲线。结果健康对照组受试者、AKI组、CKD组患者SWV值分别为(2.88±0.63)、(2.42±0.83)、(2.06±0.72)m/s。AKI组、CKD组患者SWV值均小于健康对照组,且差异均有统计学意义(t=2.158,P=0.033;t=5.234,P<0.001);CKD组患者SWV值小于AKI组患者,但两者差异无统计学意义。不合并及合并CKD的AKI组患者SWV值分别为(2.60±0.84)、(1.80±0.45)m/s。合并CKD的AKI组患者及CKD组患者SWV值均低于健康对照组受试者及不合并CKD的AKI组患者,且差异均有统计学意义(与健康对照组比较,t=2.916、P=0.004,t=5.318、P<0.001;与不合并CKD的AKI组比较,t=2.054、P=0.043,t=-2.517、P=0.013),但合并CKD的AKI组与CKD组患者、不合并CKD的AKI组患者与健康对照组SWV值差异均无统计学意义。ROC曲线显示,以肾皮质SWV值2.40 m/s作为诊断肾病的阈值,曲线下面积为0.767(95%CI 0.689~0.898,P=0.000),敏感度及特异度分别为57.1%及81.9%。结论中老年CKD及AKI患者SWV值明显小于健康志愿者。合并CKD的AKI患者SWV值较不合并CKD的AKI患者低。ARFI技术在诊断中老年肾病患者中具有较好�Objectives To investigate the efficacy of the shear wave velocity（SWV） based on acoustic radiation force impulse（ARFI） elastography in the differentiation of normal population with chronic kidney disease（CKD） and acute kidney injury（AKI） in middle aged and elderly patients. Methods Sixty-four middle aged and elderly patients referred to China-Japan Friendship Hospital and Zhejiang Provincial People′s Hospital with AKI or CKD were enrolled in this study from February 2015 to December 2016（kidney disease group）. Among them, 43 patients were CKD（CKD group）, and 21 patients were AKI（AKI group, 15 patients combined with prior CKD, 6 patients without prior CKD）. Twenty-nine middle aged and elderly healthy volunteers from China-Japan Friendship Hospital were enrolled at the same time（healthy control group）. The SWV values of the renal middle pole cortex were acquired using the ARFI elastography. The differences of the kidney length, cortical thickness and SWV values among healthy control group, AKI and CKD group were compared by variance analysis. The LSD-t analysis was used for the advanced comparison between any two groups. The differences of cortical SWV values among healthy control group, AKI combined with prior CKD group, AKI without prior CKD group and CKD group were compared by variance analysis. The LSD-t analysis was used for the advanced comparison between any two groups. The receiver operating characteristic（ROC） curves of the cortical SWV values for diagnosing kidney disease was drawn. Results The mean cortical SWV values of healthy control group, AKI and CKD groups were（2.88±0.63）,（2.42±0.83） and（2.06±0.72） m/s, respectively. The SWV values of AKI and CKD groups were significantly lower than that of healthy control group（t=2.158, P=0.033; t=5.234, P〈0.001）. The SWV values of CKD group were lower than that of AKI group, but there were no significant differences. The SWV values of AKI without previous CKD group and AKI combined with prior CKD group we

关 键 词：慢性肾病 急性肾损伤 弹性成像技术 中年人 老年人 

分 类 号：R445.1[医药卫生—影像医学与核医学] R692[医药卫生—诊断学]