超声造影对高血压肾动脉狭窄程度、肾皮质血流灌注的评估价值及临床意义  

Values of Contrast-enhanced Ultrasound in Evaluation of Degree of Renal Artery Stenosis and Renal Cortical Blood Perfusion in Hypertensive Patients and Its Clinical Significance

作　　者：高艳 曾欣 王会 杨林[1] 文宏 GAO Yan;ZENG Xin;WANG Hui;YANG Lin;WEN Hong(Department of Ultrasound,the Third People's Hospital of Chengdu City,Chengdu 610000,China)

机构地区：[1]成都市第三人民医院超声科,成都610000

出　　处：《临床误诊误治》2021年第12期20-24,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨超声造影对高血压肾动脉狭窄程度、肾皮质血流灌注的评估价值及临床意义。方法选取2019年1月—2021年1月收治的122例高血压病,根据肾动脉数字减影血管造影检查分为无狭窄组33例、轻度狭窄组33例、中度狭窄组32例、重度狭窄组24例,均行超声造影检查。比较各组基线资料、肾皮质血流灌注曲线下面积(AUC)、平均渡越时间(MTT)、峰值强度(PI)、达峰时间(TTP)、上升支斜率(A)。采用受试者工作特征(ROC)曲线分析AUC、MTT、PI、TTP、A诊断高血压肾动脉狭窄的效能,AUC、MTT、PI、TTP、A与肾动脉狭窄程度关系应用Spearman相关分析,与肾小球滤过率(GFR)的关系应用Pearson相关分析。结果无狭窄组及轻、中、重度狭窄组舒张压、收缩压、MTT、TTP依次升高,GFR、AUC、PI、A依次降低(P<0.05)。肾功能正常及轻、中、重度肾功能不全患者AUC、PI、A依次降低,MTT、TTP依次升高(P<0.05)。AUC、PI、A与肾动脉狭窄程度呈负相关,与GFR呈正相关(P<0.01);MTT、TTP与肾动脉狭窄程度呈正相关,与GFR呈负相关(P<0.01)。AUC、MTT、PI、TTP、A联合诊断高血压肾动脉狭窄的ROC曲线AUC最大,为0.956。结论超声造影可同步评估高血压肾动脉狭窄程度及肾皮质血流灌注情况,且肾皮质血流灌注参数与GFR显著相关。Objective To investigate values of contrast-enhanced ultrasound in evaluation of degree of renal artery stenosis and renal cortical blood perfusion in hypertensive patients and its clinical significance.Methods A total of 122 patients with hypertension admitted between January 2019 and January 2021 were selected and divided into non-stenosis group(n=33),mild stenosis group(n=33),moderate stenosis group(n=32)and severe stenosis group(n=24)according to results of renal artery digital subtraction angiography.All patients underwent contrast-enhanced ultrasound examinations.Levels of baseline data,area under curve of the renal cortex blood perfusion(AUC),mean transit time(MTT),peak intensity(PI),time to peak(TTP),and ascending branch slope(A)were compared among groups.Receiver operating characteristic(ROC)curve was used to analyze efficiency values of AUC,MTT,PI,TTP and A in diagnosing hypertensive renal artery stenosis.Correlations between AUC,MTT,PI,TTP and A with the degree of renal artery stenosis were analyzed by Spearman correlation analysis,and their correlations with glomerular filtration rate(GFR)were analyzed by Pearson correlation analysis.Results Levels of diastolic blood pressure(DBP),systolic blood pressure(SBP),MTT and TTP were increased in turn,while levels of GFR,AUC,PI and A were decreased in turn in non-stenosis,mild stenosis,moderate stenosis and severe stenosis groups(P<0.05).Levels of AUC,PI,and A were decreased in turn,while levels of MTT and TTP were increased in turn in patients with normal renal function,mild renal insufficiency,moderate renal insufficiency and severe renal insufficiency(P<0.05).AUC,PI and A were negatively correlated with the degree of renal artery stenosis and positively correlated with GFR(P<0.01).MTT and TTP were positively correlated with the degree of renal artery stenosis and negatively correlated with GFR(P<0.01).The AUC of ROC curve of combined detection for MTT,PI,TTP and A in diagnosis of hypertensive renal artery stenosis was the largest,which was 0.956.Conclusion

关 键 词：高血压 肾动脉狭窄 超声造影 肾皮质血流灌注 肾小球滤过率 诊断 

分 类 号：R544.1[医药卫生—心血管疾病] R692[医药卫生—内科学]