多模态超声监测DBD移植肾的临床应用  

Clinical Application of Multimodal Ultrasound inMonitoring DBD Renal Transplantation

作　　者：杨皖东 李永峰 肖春华[1] 普慧敏 李鸿[1] 杨薇[1] 沈燕[1] 丁世兰 朱成诚 闵湘凤 YANG Wandong;LI Yongfeng;XIAO Chunhua;PU Huimin;LI Hong;YANG Wei;SHEN Yan;DING Shilan;ZHU Chengcheng;MIN Xiangfeng(Dept.of Ultrasound,Calmette Hospital Affiliated to Kunming Medical University,Kunming Yunnan 650224;Dept.of Ultrasound,Kunming Second People's Hospital,Kunming Yunnan 650224,China)

机构地区：[1]昆明医科大学附属甘美医院超声科,云南昆明650224 [2]昆明市第二人民医院超声科,云南昆明650224

出　　处：《昆明医科大学学报》2022年第3期113-122,共10页Journal of Kunming Medical University

基　　金：昆明市科技计划项目(2019-1-S-25318000001035)。

摘　　要：目的评估多模态超声在DBD移植肾功能及术后并发症监测中的价值。方法选取昆明医科大学附属甘美医院2019年7月至2021年6月脑死亡器官捐献移植肾(DBD)67例,运用多模态超声对移植肾进行评估。以血肌酐将移植肾分为功能正常组和异常组,异常组以穿刺病理分为急性排斥组、慢性排斥组,病毒性肾病组,纤维化组、药物损伤组。采用相关性分析动脉峰值流速(PSV)、舒张期流速(EDV)、阻力指数(RI)与血肌酐的相关性。比较超声造影与病理或DSA在移植肾并发症中的诊断效能,分析超声造影参数与移植肾功能间相关性。采用秩和检验分别比较各异常组与正常组杨氏模量值。绘制ROC曲线,以约登指数最高时的杨氏模量值作为区分正常和异常移植肾的截断值,计算相应敏感度、特异度。结果移植肾各血流参数与血肌酐的相关性一般,相关系数均<0.5。慢性排斥组(8例)较正常组(10例)到达时间和达峰时间明显延长,差异具有统计学意义。超声造影诊断假性动脉瘤2例,移植肾缺血2例,移植肾静脉血栓形成1例,均经病理或DSA证实。根据血肌酐值将62例移植肾分为正常组22例、异常组40例(急性排斥组5例、慢性排斥组11例,病毒性肾病组10例,纤维化组10例、药物损伤组4例)。急性排斥组肾主动脉RI高于正常组、慢性排斥组叶间动脉RI高于正常组,主、叶间EDV低于正常组,叶间动脉PSV低于正常组、纤维化组主PSV低于正常组。以上差异具有统计学意义(P<0.05);病毒性肾病、药物损伤组与正常组各参数差异无统计学意义(P>0.05)。异常组和正常组移植肾STE杨氏模量值分别为22.550(17.1,28.1)和13.370(11.8,15.9)kPa,差异有统计学意义(P<0.01)。截断值=17.31 kPa时,剪切波弹性成像诊断移植肾病变的灵敏度、特异度为75%、91%。异常组和正常组移植肾STQ杨氏模量值分别为21.760(16.4,33.4)和13.870(10.5,16.8)kPa,差异有统计�Objective To evaluate the value of multimodal ultrasound in monitoring renal function and postoperative complications of DBD transplantation.Methods 67 cases of brain dead organ donor kidney transplantation(DBD)in Ganmei Hospital Affiliated to Kunming Medical University from July 2019 to June 2021 were selected to evaluate the transplanted kidney by multimodal ultrasound.The transplanted kidneys were divided into normal function group and abnormal group according to blood creatinine.The abnormal group was divided into acute rejection group,chronic rejection group,viral nephropathy group,fibrosis group and drug injury group according to puncture pathology.The correlation between arterial peak velocity(PSV),diastolic velocity(EDV),resistance index(RI)and serum creatinine was analyzed.To compare the diagnostic efficacy of contrast-enhanced ultrasound with pathology or DSA in renal transplantation complications,and to analyze the correlation between contrast-enhanced ultrasound parameters and renal transplantation function.Rank sum test was used to compare the young’s modulus between abnormal group and normal group.The ROC curve was drawn,and the young’s modulus at the highest yoden index was used as the cut-off value to distinguish normal and abnormal transplanted kidneys,and the corresponding sensitivity and specificity were calculated.Results The correlation between blood flow parameters of transplanted kidney and serum creatinine was general,and the correlation coefficients were less than0.5.The arrival time and peak time of chronic rejection group(8 cases)were significantly longer than those of normal group(10 cases),and the difference was statistically significant.Two cases of pseudoaneurysm,two cases of graft ischemia and one case of graft venous thrombosis were diagnosed by contrast-enhanced ultrasonography,which were confirmed by pathology or DSA.According to the serum creatinine value,62 cases of transplanted kidney were divided into 22 cases in the normal group and 40 cases in the abnormal group(5 case

关 键 词：多模态超声 移植肾 并发症 移植肾功能 排斥反应 

分 类 号：R445.1[医药卫生—影像医学与核医学]