一种新的急性梗阻性肾盂肾炎的CT影像学分级体系  

A new CT imaging grading system for acute obstructive pyelonephritis

作　　者：张剑平[1] 林荣凯[1] 邓超雄[1] 杨朝裕 潘润阳[1] 庄惠强[1] 洪梓煌 徐航[1] ZHANG Jianping;LIN Rongkai;DENG Chaoxiong;YANG Chaoyu;PAN Runyang;ZHUANG Huiqiang;HONG Zihuang;XU Hang(Department of Urinary Surgery,The Affiliated Haixia Hospital of Huaqiao University(910^th Hospital of PLA),Quanzhou,Fujian 362000,China)

机构地区：[1]华侨大学附属海峡医院(解放军第九一〇医院)泌尿外科

出　　处：《安徽医药》2019年第12期2428-2431,共4页Anhui Medical and Pharmaceutical Journal

基　　金：福建省泉州市科技项目(2018Z143)

摘　　要：目的观察急性梗阻性肾盂肾炎的CT影像学特征,并建立新的分级体系。方法回顾性分析2014年4月至2018年4月解放军第九一〇医院152例上尿路结石引起的急性梗阻性肾盂肾炎病人CT图像。根据尿液及炎症渗出侵犯肾脏的范围及程度,将CT图像分为不同等级。比较不同CT分级病人的临床特征、血常规、尿常规。结果将CT图像分为4个等级。1级:肾盂肾盏壁增厚、肾盂肾盏轻度扩张、肾窦脂肪间隙模糊,未侵犯肾实质;2级:肾实质局部增厚、密度减低,肾实质出现局部楔形肿胀及低密度灶,范围≤50%;3级:肾实质侵犯范围大于50%;4级:肾包膜炎性渗出毛糙,肾周脂肪间隙密度增高,肾筋膜增厚,或肾脏及肾周脓肿形成。CT分级为1级有52例,占34.2%;2级有30例,占19.7%;3级有30例,占19.7%;4级有40例,占26.3%。CT分级越高的病人,血白细胞升高越明显(P<0.05),腰痛、发热的发生率越高(P<0.05)。结论该CT分级可以反映急性上尿路梗阻时肾脏感染受累程度、范围以及可能存在并发症,对急性肾盂肾炎的诊断及预后的判断具有十分重要的临床实用价值。Objective To investigate the CT imaging features of acute obstructive pyelonephritis and to establish a new grading sys tem.Methods A retrospective analysis was made of CT images of 152 patients who were admitted to the 910th Hospital of PLA from April 2014 to April 2018 with acute obstructive pyelonephritis resulted from upper urinary tract calculi.CT images were as signed into different grades according to the range and extent of urine and inflammation invading the kidney.A comparison was made of the clinical features,blood routine,and urine routine of patients with different CT grades.Results The CT images were as signed into 4 grades.Grade 1:dilatation and thickening of renal pelvis and renal calyx,fuzzy fat of renal sinusoid,and no invasion of renal parenchyma.Grade 2:local thickening and decreased density of renal parenchyma,local wedge shaped swelling and low density foci in renal parenchyma with a range less than or equal to 50%.Grade 3:the invasion range of renal parenchyma greater than 50%.Grade 4:inflammatory exudation of renal capsule,increased density of perirenal fat,thickening of renal fascia and forma tion of perirenal abscess.There were 52 cases at grade 1(34.2%),30 cases at grade 2(19.7%),30 cases at grade 3(19.7%),and 40 cases at grade 4(26.3%).The higher the CT grade,the more obvious the increase in the white blood cells(P<0.05),the high er the incidence of low back pain and fever(P<0.05).Conclusion CT grading can indicate the degree,extent and possible com plications of renal infection in patients with acute upper urinary tract obstruction.It is also very important for the diagnosis and prognosis of acute pyelonephritis.

关 键 词：肾盂肾炎 尿道梗阻 尿路结石 体层摄影术 X线计算机 诊断技术 泌尿科 

分 类 号：R69[医药卫生—泌尿科学]