超声监测移植肾功能及鉴别肾功能异常组织学类型  

Ultrasound in monitoring function and identifyingpathological type of renal graft

作　　者：王天驰[1] 唐缨[1] 王众[1] 刘菁[1] WANG Tianchi;TANG Ying;WANG Zhong;LIU Jing(Department of Ultrasound,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院超声科,天津300192

出　　处：《中国医学影像技术》2021年第4期577-581,共5页Chinese Journal of Medical Imaging Technology

基　　金：天津市科技计划项目新一代人工智能科技重大专项(18ZXZNSY00250)。

摘　　要：目的观察超声监测移植肾功能及鉴别肾功能异常组织学类型的价值。方法以211例肾移植术后肌酐异常接受穿刺活检患者为异常组(A组),80例同期移植肾功能转归正常患者为对照组(B组),回顾2组移植肾二维、彩色及能量多普勒超声数据,对移植肾体积变化率(V-rate)、叶间动脉峰值血流速度(PSV)、舒张末期血流速度(EDV)、阻力指数(RI)、搏动指数(PI)及能量图信号分级(Power)进行统计分析,以受试者工作特征(ROC)曲线分析其对肾功能异常的诊断效能。按照病理类型将A组分为急性排斥反应亚组(A1组)和其他病变亚组(A2组),分析超声对急性排斥反应的鉴别诊断效能。结果A组V-rate显著高于B组(P<0.05),2组RI分布及Power差异均有统计学意义(P均<0.05),其余各参数差异均无统计学意义(P均>0.05),V-rate、RI和Power诊断移植肾功能异常的曲线下面积(AUC)分别为0.576、0.542和0.810,三者联合AUC为0.843,敏感度90.50%,特异度57.50%。V-rate、RI和Power鉴别移植肾急性排斥反应的AUC分别为0.562、0.522和0.551,三者联合AUC 0.647,敏感度69.20%,特异度55.00%。结论超声对于监测移植肾功能、鉴别移植肾功能异常组织学类型具有一定价值。Objective To observe the value of ultrasound in monitoring function and identifying pathological type of renal graft.Methods A total of 211 patients with abnormal serum creatinine who underwent biopsy after renal transplantation were enrolled as creatinine abnormal group(group A).Meanwhile,80 patients with normal renal function after renal transplantation were selected as control(group B).Two-dimensional ultrasound,color Doppler and power Doppler ultrasonography of were performed,the renal allograft volume changing rate(V-rate),peak systolic velocity(PSV)of interlobal artery,end-diastolic velocity(EDV),resistance index(RI),pulsatility index(PI)and power grading(Power)were compared between groups,receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of ultrasonic features in renal allograft dysfunction.According to pathology results,patients in group A were divided into acute rejection subgroup(group A1)and other pathological types subgroup(group A2),and the differential diagnostic efficacy of ultrasound on acute rejection was analyzed.Results V-rate of group A was significantly higher than that of group B(P<0.05).Significantly differences of RI distribution and Power were detected between groups(both P<0.05),but there was no statistical difference of other parameters(all P>0.05).The area under the curve(AUC)of V-rate,RI and Power for renal allograft dysfunction was 0.576,0.542 and 0.810,respectively,of combination of the above three parameters was 0.843,with sensitivity 90.50%and specificity 57.50%.AUC of V-rate,RI and Power for differentiating acute rejection of renal transplantation was 0.562,0.522 and 0.551,respectively,of combination of them was 0.647,with sensitivity of 69.20%and specificity of 55.00%.Conclusion Ultrasound was valuable for monitoring renal function and identifying pathological type of renal graft.

关 键 词：肾移植 移植物排斥 超声检查 

分 类 号：R692[医药卫生—泌尿科学] R445.1[医药卫生—外科学]