彩色多普勒超声观察慢性砷中毒肾损伤患者肾血流动力学改变  

Observation of renal hemodynamics in patients with chronic arsenism and renal injury by color Doppler ultrasound

作　　者：牛宁宁[1] 张学娜[1] 贾红飞 Niu Ningning;Zhang Xuena;Jia Hongfei(Department of Ultrasound Medicine,Binzhou People's Hospital,Binzhou 256600,China)

机构地区：[1]山东省滨州市人民医院超声医学科,256600

出　　处：《中华地方病学杂志》2020年第11期825-829,共5页Chinese Journal of Endemiology

摘　　要：目的探讨彩色多普勒超声对慢性砷中毒致肾损伤的诊断及肾血流动力学观察。方法选择2018年1月至2019年4月滨州市人民医院收治的职业性慢性砷中毒患者作为研究对象,按照患者是否并发肾损伤将患者分为肾损伤组(26例)、无肾损伤组(48例)。检测两组患者肾功能指标[血肌酐(SCr),血尿素氮(BUN),尿、血β2-微球蛋白(β2-MG)]水平,彩色多普勒超声法检测肾血流动力学指标[收缩期峰值血流速度(Vmax)、舒张期最低血流速度(Vmin)、阻力指数(RI)],并分析肾功能指标与肾血流动力学的相关关系。结果肾损伤组患者SCr、BUN、尿β2-MG以及血β2-MG水平[(136.28±21.05)μmol/L,(8.03±1.04)mmol/L,(157.48±25.63)μg/L,(3.97±1.12)mg/L]均高于无肾损伤组[(108.42±26.49)μmolL,(5.36±0.97)mmol/L,(127.42±18.95)μg/L,(2.35±0.84)mg/L,t=4.625、11.022、5.740、7.028,P均<0.05]。肾损伤组患者主肾动脉及小叶间动脉Vmax、Vmin[(50.34±13.42)、(18.13±5.21),(12.31±3.82)、(4.08±1.15)cm/s]均低于无肾损伤组[(75.32±16.52)、(29.83±7.05),(17.22±5.07)、(6.03±1.93)cm/s,t=6.833、7.084、4.657、4.775,P均<0.05],肾损伤组患者主肾动脉及小叶间动脉RI(0.71±0.06,0.68±0.10)显著高于无肾损伤组(0.62±0.080.56±0.08,t=5.017、5.634,P均<0.05)。主肾动脉、小叶间动脉Vmax、Vmin值与SCr、BUN、尿β2-MG、血β2-MG呈显著负相关(P均<0.05),主肾动脉、小叶间动脉RI与SCr、BUN、尿β2-MG、血β2-MG呈显著正相关(P均<0.05)。结论彩色多普勒超声可有效反应慢性砷中毒患者肾损伤状况,肾损伤患者肾血流灌注降低、血流阻力增大,且与肾脏损伤程度密切相关,值得临床关注。Objective To analyze the diagnosis of renal injury caused by chronic arsenism by color Doppler ultrasound and the observation of renal hemodynamics.Methods From January 2018 to April 2019,74 patients with occupational chronic arsenism admitted to Binzhou People's Hospital were selected and divided into two groups according to whether the patients were complicated with renal injury or not,26 patients in renal injury group and 48 patients in non-renal injury group.The renal function indexes[serum creatinine(SCr),blood urea nitrogen(BUN),urine and blood β2-microglobulin(β2-MG)]were measured and the renal hemodynamics[peak blood flow velocity during systole(Vmax),minimum blood flow velocity during diastole(Vmin),resistance index(RI)]of the two groups were analyzed by color Doppler ultrasound,and the correlation between renal function indexes and renal hemodynamics was analyzed.Results The levels of SCr,BUN,urine β2-MG and blood β2-MG in renal injury group were significantly higher than those in non-renal injury group[(136.28±21.05)vs(108.42±26.49)μmol/L,(8.03±1.04)vs(5.36±0.97)μmol/L,(157.48±25.63)vs(127.42±18.95)μg/L,(3.97±1.12)vs(2.35±0.84)mg/L,t=4.625,11.022,5.740,7.028,P<0.05].The Vmax and Vmin of the main renal artery and interlobular artery in renal injury group were significantly lower than those in non-renal injury group[cm/s:(50.34±13.42)vs(75.32±16.52),(18.13±5.21)vs(29.83±7.05),(12.31±3.82)vs(17.22±5.07),(4.08±1.15)vs(6.03±1.93),t=6.833,7.084,4.657,4.775,P<0.05],and the RI of the main renal artery and interlobular artery in renal injury group was significantly higher than that in non-renal injury group[(0.71±0.06)vs(0.62±0.08),(0.68±0.10)vs(0.56±0.08),t=5.017,5.634,P<0.05].Vmax and Vmin of the main renal artery and interlobular artery were negatively correlated with SCr,BUN,urine β2-MG and blood β2-MG(P<0.05).RI of the main renal artery and interlobular artery were positively correlated with SCr,BUN,urine β2-MG and blood β2-MG(P<0.05).Conclusions Color Doppler ultrasound can

关 键 词：彩色多普勒超声 慢性砷中毒 肾损伤 肾血流动力学 

分 类 号：R599.1[医药卫生—内科学] R692[医药卫生—临床医学]