超声造影定量分析重度失血性休克再灌注模型大鼠复苏期的肾血流灌注  

Quantitative analysis of renal blood flow perfusion using contrast-enhanced ultrasound in rats with hemorrhagic shock during resuscitation

作　　者：曾祯 胡经纬 李璇 唐琳梅 黄志强 李明星 Zeng Zhen;Hu Jingwei;Li Xuan;Tang Linmei;Huang Zhiqiang;Li Mingxing(Department of Ultrasound,the First Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan Province,China)

机构地区：[1]西南医科大学附属医院超声科,四川省泸州市646000

出　　处：《中国组织工程研究》2021年第8期1201-1206,共6页Chinese Journal of Tissue Engineering Research

基　　金：四川省教育厅科研资助课题(142A0139),项目负责人:李明星。

摘　　要：背景:肾脏血流灌注量往往与肾功能呈平行关系,若能利用超声造影技术实时定量分析复苏期肾血流灌注变化来间接反映肾功能,这将为临床评估失血性休克再灌注肾损伤提供一个新的思路。目的:建立SD大鼠重度失血性休克再灌注模型,探讨超声造影参数评估肾脏血流灌注的价值。方法:20只雄性SD大鼠随机分4组,每组5只,假手术组、失血休克再灌注组2,6,24 h组。各组对应时间行超声造影检查并获得峰值强度、达峰时间、曲线下面积、平均渡越时间定量参数,分析时间-强度曲线参数与血肌酐、尿素氮水平、肾组织髓过氧化物酶、内皮素1、前列腺素E1水平的相关性。结果与结论:与假手术组比较,失血休克再灌注组病理损伤显著,达峰时间、平均渡越时间延长,曲线下面积、峰值强度值增大(P<0.05),血清肌酐、尿素氮水平升高,以再灌注24 h损伤最严重,再灌注各组间达峰时间、平均渡越时间差异有显著性意义。双变量Pearson相关性分析显示时间-强度曲线参数达峰时间、平均渡越时间与血肌酐、尿素氮水平、肾组织髓过氧化物酶、内皮素1、前列腺素E1水平均存在显著相关性。结果表明:①超声造影能够有效地监测失血性休克复苏进程中肾脏的血流灌注变化,并能够进行定量评估;②时间-强度曲线中达峰时间、平均渡越时间2个指标具有一定参考价值;③失血性休克再灌注后,肾脏损伤未减轻反而加重,复苏后24 h损伤最严重;④超声造影为临床评估失血性休克再灌注肾损伤提供了一个新的思路。BACKGROUND:The amount of renal blood perfusion is often in parallel with renal function.If contrast-enhanced ultrasound(CEUS)can be used to quantitatively analyze changes in renal blood flow perfusion during resuscitation so as to indirectly reflect changes in renal function,this will provide a new way for the clinical assessment of hemorrhagic shock-reperfusion injury of the kidney.OBJECTIVE:To establish a reperfusion model of severe hemorrhagic shock in Sprague-Dawly rats and to explore the value of CEUS parameters in evaluating renal perfusion.METHODS:Twenty male Sprague-Dawley rats were randomly divided into four groups,five in each group:sham operation group,and 2-,6-,and 24-hour hemorrhagic shock reperfusion groups(2-,6-,and 24-hour HS-R groups).CEUS examination was performed in each group,and the quantitative parameters of peak intensity,time to peak,area under curve,average transit time were checked and obtained.The correlation between time-intensity curve parameters and serum creatinine,urea nitrogen,renal tissue myeloperoxidase,endothelin 1,and prostaglandin E1 levels was analyzed.RESULTS AND CONCLUSION:Compared with the sham operation group,the pathological injury was significant in the HS-R groups,especially in the HS-R group,with increased peak intensity,time to peak,area under curve,and average transit time(P<0.05)as well as increased serum creatinine and urea nitrogen levels.There were significant differences in peak arrival time and average transit time among groups.Bivariate Pearson’s correlation analysis showed that time to peak and average transit time were significantly correlated with serum creatinine,urea nitrogen,renal tissue myeloperoxidase,endothelin 1,and prostaglandin E1 levels.To conclude,(1)CEUS can effectively monitor and quantitatively evaluate the renal perfusion changes during the recovery of hemorrhagic shock.(2)Time to peak and average transit time are two indexes of the time-intensity curve with some reference value.(3)After hemorrhagic shock and reperfusion,the kidney injury

关 键 词：肾 失血性休克 再灌注 超声造影 肾功能 肾损伤 大鼠 

分 类 号：R445.1[医药卫生—影像医学与核医学] R318[医药卫生—诊断学]