MRI评估亲属活体肾移植前后保留肾和移植肾的灌注及血氧改变  

Longitudinal value of MRI in evaluating renal perfusion and blood oxygen changes in retained and transplanted kidneys before and after living kidney transplantation

作　　者：陈丽华 毛凡 任涛 谢双双[2] 付迎欣[4] 莫春柏[4] 王振[4] 夏爽[2] 沈文[2] 张雪宁[1] Chen Lihua;Mao Fan;Ren Tao;Xie Shuangshuang;Fu Yingxin;Mo Chunbai;Wang Zhen;Xia Shuang;Shen Wen;Zhang Xuening(Department of Radiology,The Second Hospital of Tianjin Medical University,Tianjin 300211,China)

机构地区：[1]天津医科大学第二医院放射科,300211 [2]天津市第一中心医院放射科,300192 [3]天津市环湖医院放射科,300350 [4]天津市第一中心医院器官移植中心,300192

出　　处：《中华器官移植杂志》2019年第12期728-733,共6页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金(81873888);天津市自然科学基金(16JCYBJC27300)。

摘　　要：目的探讨磁共振技术动脉自旋标记(ASL)和血氧水平依赖(BOLD)在亲属活体肾移植手术前后对保留肾和移植肾灌注及血氧改变纵向评估价值。方法纳入15对拟行亲属活体肾移植术的健康肾移植供者以及与之相对应的受者,供者术前3d、术后2周、3个月、6个月行MRI检查,受者术后2周、3个月、6个月行MRI检查,包括ASL和BOLD检查。通过后处理获得肾血流、血氧相关参数,包括肾皮质血流量(RBF)值、皮髓质表观驰豫率(R2^*)。收集移植肾术前及术后2周肾功能信息。采用Pearson相关分析比较各参数值与肾功能的相关性;采用单因素重复测量的方差分析比较不同时间点各参数值的差异;采用线性回归分析评估术后不同时间点皮髓质R2^*值变化和RBF值变化的相关性。结果术后2周保留肾皮、髓质R2^*值较术前明显减低,术后3个月时较术后2周水平升高,但仍然低于术前水平,差异均具有统计学意义(P<0.05)。术后2周保留肾RBF值较术前上升,术后3个月时较术后2周下降,但仍高于术前水平,差异有统计学意义(P均<0.05)。术后2周移植肾皮质RBF值、皮髓质R2^*值较术前均减低(P<0.05),而术后3个月较术后2周水平升高,但仍然低于术前水平,差异有统计学意义(P<0.05);术后半年时各参数与术后3个月比较差异无统计学意义(P>0.05)。移植肾、保留肾术前、术后2周皮、髓质R2^*值与肾功能均呈中等负相关性;皮质RBF值与肾功能均呈中等正相关性。移植肾皮质RBF值变化与皮髓质R2^*值变化无明显相关(P>0.05)。结论ASL和BOLD MRI能够纵向评价亲属活体肾移植供肾前后保留肾和移植肾血流、血氧水平的微观改变情况,有望成为监测肾功能的一种手段。Objective To explore the value for longitudinal evaluating renal perfusion and blood oxygen changes in retained and transplanted kidneys before and after living kidney transplantation by magnetic resonance technique of(arterial spin labeling,ASL)and blood oxygen level dependent(BOLD).Methods Fifteen healthy kidney donors and their corresponding recipients undergoing parental kidney transplantation were recruited.All donors received MRI within 3 days pre-transplantation and at 2 weeks and 3/6 months post-transplantation.And all allografts were re-examined by MRI(BOLD&ASL)at 2 weeks and 3/6 months post-transplantation.Renal blood flow and oxygen related parameters of renal cortical blood flow(RBF)and cortical&medullary apparent relaxation rate(R2^*)were acquired by post-processing.Glomerular filtration rate(GFR)or estimated glomerular filtration rate(eGFR)of donors and recipients were collected.Pearson's correlation analysis was utilized for comparing the correlation between parameters and GFR/eGFR.The differences in cortical RBF and R2^*values of cortex and medulla among different timepoints were analyzed using one factor repeated measures ANOVA.The correlations between the change in cortical RBF and R2^*values at 2 weeks post-transplantation were analyzed by linear regression.Results The R2^*value of retained renal cortex and medulla at 2 weeks post-transplantation decreased markedly and increased at 3 months significantly(P<0.05).However,it was still lower than that pre-operation.Cortical RBF value of retained kidney increased at 2 weeks post-transplantation and decreased at 3 months significantly(P<0.05).However,it was still higher than that pre-operation.Cortical RBF values at 2 weeks post-transplantation were lower than that at pre-transplantation,as well as cortical and medullary R2^*values significantly(P<0.05),and increased at 3 months and remained lower than that at pre-transplantation.The R2^*values of cortex and medulla were moderately correlated with renal function negatively,and RBF values of cortex w

关 键 词：肾移植 血氧水平 分肾功能 灌注 

分 类 号：R699[医药卫生—泌尿科学] R44[医药卫生—外科学]