声辐射力脉冲成像诊断儿童慢性肾病  

Acoustic radiation force impulse imaging for diagnosis of chronic kidney disease in children

作　　者：程果[1] 滑少华[1] 郭燕丽 史佩佩[3] 张建江[3] CHENG Guo;HUA Shaohua;GUO Yanli;SHI Peipei;ZHANG Jianjiang(Department of Ultrasound,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Ultrasound,the Southwest Hospital of AMU,Chongqing 400038,China;Department of Pediatrics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院超声科,河南郑州450052 [2]陆军军医大学西南医院超声科,重庆400038 [3]郑州大学第一附属医院小儿科,河南郑州450052

出　　处：《中国医学影像技术》2021年第10期1524-1528,共5页Chinese Journal of Medical Imaging Technology

基　　金：河南省医学科技攻关计划(201702045)。

摘　　要：目的观察声辐射力脉冲(ARFI)成像评估儿童慢性肾脏疾病(CKD)的价值。方法纳入40例CKD患儿(CKD组)及40名健康儿童(对照组),采用ARFI成像测量肾皮质剪切波速度(SWV)。计算估算肾小球滤过率(eGFR),并将CKD组分为eGFR<60 ml/(min·1.73 m^(2))亚组和eGFR≥60 ml/(min·1.73 m^(2))亚组;比较组及各亚组间肾SWV及肾功能指标,观察肾SWV与肾功能指标的相关性。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估SWV诊断CKD的效能。结果CKD组肾SWV、血肌酐、尿素氮及尿酸均高于对照组(P均<0.05),而eGFR低于对照组(P<0.05)。CKD组平均肾SWV与血肌酐均与尿素氮呈正相关(r=0.46、0.54,P均<0.01),与eGFR呈负相关(r=-0.44,P<0.01),而与尿酸无明显相关(r=0.22,P=0.09);其内eGFR<60 ml/(min·1.73 m^(2))亚组和eGFR≥60 ml/(min·1.73 m^(2))亚组血肌酐、尿素氮、尿酸、eGFR和平均肾SWV差异均有统计学意义(P均<0.05)。eGFR<60 ml/(min·1.73 m^(2))亚组平均肾SWV与血肌酐和尿素氮均呈正相关(r=0.48、0.47,P均<0.05),与eGFR呈负相关(r=-0.76,P<0.01),而与尿酸无明显相关(r=0.07,P>0.05)。以SWV=2.60 m/s为截断值,其诊断CKD的敏感度和特异度分别为67.50%和87.50%,AUC为0.80(P<0.01)。以SWV=2.66 m/s为截断值,其评估CKD患儿eGFR<60 ml/(min·1.73 m^(2))或≥60 ml/(min·1.73 m^(2))的敏感度和特异度分别为83.30%和59.10%,AUC为0.69(P=0.03)。结论以ARFI成像测量肾皮质SWV有助于诊断儿童CKD,尤其是eGFR<60 ml/(min·1.73 m^(2))的CKD。Objective To observe the value of acoustic radiation force impulse(ARFI)imaging for diagnosing chronic kidney disease(CKD)in children.Methods Forty children with CKD(CKD group)and 40 healthy children(control group)were enrolled.The shear wave velocity(SWV)of renal cortex was measured with ARFI imaging,and then children in CKD group were divided into estimate glomerular filtration rate(eGFR)<60 ml/(min·1.73 m^(2))subgroup and eGFR≥60 ml/(min·1.73 m^(2))subgroup according to eGFR.The renal SWV and renal function indexes were compared between groups and/or subgroups,and the correlations of renal SWV and renal function indexes were analyzed.The receiver operating characteristic(ROC)curve was drawn,the area under the curve(AUC)was calculated to evaluate the efficacy of SWV for diagnosing CKD.Results Renal SWV,serum creatinine,urea nitrogen and uric acid in CKD group were all higher than those in control group(all P<0.05),while eGFR was lower than that in control group(P<0.05).In CKD group,the mean renal SWV was positively correlated with serum creatinine and urea nitrogen(r=0.46,0.54,both P<0.01),negatively correlated with eGFR(r=-0.44,P<0.01),but not significantly correlated with uric acid(r=0.22,P=0.09).There were significant differences of serum creatinine,urea nitrogen,uric acid,eGFR and mean renal SWV between eGFR<60 ml/(min·1.73 m^(2))subgroup and eGFR≥60 ml/(min·1.73 m^(2))subgroup(all P<0.05).In eGFR<60 ml/(min·1.73m^(2))subgroup,the mean renal SWV was positively correlated with serum creatinine and urea nitrogen(r=0.48,0.47,both P<0.05),negatively correlated with eGFR(r=-0.76,P<0.01),but not significantly correlated with uric acid(r=0.07,P>0.05).Taken 2.60 m/s as the cut-off value of SWV for diagnosing CKD,the sensitivity and specificity was 67.50%and 87.50%,respectively,and AUC was 0.80(P<0.01).Taken 2.66 m/s as the cut-off value of SWV for evaluating the eGFR<60 ml/(min·1.73 m^(2))or≥60 ml/(min·1.73 m^(2))in children with CKD,the sensitivity and specificity was 83.30%and 59.10%,respectively,and

关 键 词：肾功能不全 慢性 肾小球滤过率 超声检查 弹性成像技术 

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