剪切波弹性成像评价流行性出血热肾脏损害  

Shear wave elastography in evaluating kidney damage of epidemic hemorrhagic fever

作　　者：刘燕[1] 吴晓莉[1] 卢强[2] 张金兰 刘再荣 罗林法 LIU Yan;WU Xiaoli;LU Qiang;ZHANG Jinglan;LIU Zairong;LUO Linfa(Department of Ultrasound,Panzhihua Central Hospital,Panzhihua 617000,Sichuan,China;Department of Ultrasound,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Ultrasound,The People′s hospital of Yanyuan,Yanyuan 615700,Sichuan,China)

机构地区：[1]攀枝花市中心医院超声科,四川攀枝花617000 [2]四川大学华西医院超声科,四川成都610041 [3]盐源县人民医院超声科,四川凉山615700

出　　处：《西部医学》2022年第6期913-917,共5页Medical Journal of West China

基　　金：四川省卫生健康委员会科研课题(19PJ225);攀枝花市指导性科技计划项目(2019ZD-S-9)。

摘　　要：目的探讨剪切波弹性成像(SWE)评估流行性出血热(EHF)患者肾损害的可行性。方法选取2019年4月~2020年1月盐源县人民医院临床确诊EHF既往无肾脏病史且做肾脏SWE的患者20例,设为EHF组,另选取46例健康志愿者设为对照组。对比分析两组患者肾脏的杨氏模量值,绘制ROC曲线并计算曲线下面积(AUC)对应的截断值,同时收集测量杨氏模量值24 h内患者的血清肌酐、尿蛋白、尿酸和血小板计数,计算杨氏模量值与各实验室指标的相关性。结果两组患者肾皮质、髓质、肾窦的Emean、Emax、Emin参数左右侧比较,差异无统计学意义(P>0.05)。EHF组与对照组双肾皮质和髓质的Emean、Emax比较,差异有统计学意义(P<0.05)。但两组贤窦各杨氏模量E值比较,差异无统计学意义(P>0.05)。右肾皮质杨氏模量Emean值AUC为0.820,截断值为19.36 kPa时诊断流行性出血热肾损害的敏感性和特异性分别为70.0%和89.1%;左肾皮质杨氏模量Emax值AUC为0.821,截断值为30.39 kPa时诊断流行性出血热肾损害的敏感性和特异性分别为70.0%和84.8%。EHF组左肾皮质和髓质杨氏模量Emax值与尿蛋白、髓质Emean值与血清肌酐呈正相关;左肾髓质杨氏模量Emax值与血小板计数呈负相关。结论剪切波弹性成像可作为流行性出血热肾损害的无创定量评价方法,肾脏皮质及髓质Emean、Emax均可作为参考指标,而肾脏皮质杨氏模量Emean差异显著,且诊断流行性出血热肾损害的AUC较大且敏感性和特异性较高,临床应用中推荐测量肾脏皮质杨氏模量Emean值。Objective To investigate the feasibility of shear wave elastography(SWE)to evaluate the kidney damage of epidemic hemorrhagic fever patient.Methods The young′s modulus values of kidney of epidemic hemorrhagic fever patients and healthy volunteers were compared and analyzed.The ROC curve was plotted and the cut-off value of the area under the curve(AUC)was calculated.Serum creatinine,urinary protein,uric acid and platelet counts were collected and measured within 24 h of Young′s modulus.The correlation between young′s modulus and laboratory indexes was calculated.Results The young′s modulus of renal cortex,medulla and renal sinus increased in patients with epidemic hemorrhagic fever compared with healthy controls.There were statistically significant differences in Young′s modulus between cortex and medulla(P<0.05).When the Emean value of the right renal cortex was 0.820 and the cut-off value was 19.36 kPa,the sensitivity and specificity of the diagnosis of renal damage in epidemic hemorrhagic fever were 70.0%and 89.1%,respectively.When Emax value of left renal cortex was 0.821 and cut-off value was 30.39 kPa,the sensitivity and specificity of the diagnosis of renal damage in epidemic hemorrhagic fever were 70.0%and 84.8%respectively.There was a positive correlation between young′s modulus Emax of left renal cortex and medulla and urinary protein,and between medulla Emean and serum creatinine in epidemic hemorrhagic fever group.The Emax value of young′s modulus in the medulla of the left kidney was negatively correlated with platelet count.Conclusion SWE can be used as a noninvasive quantitative evaluation method for renal damage in epidemic hemorrhagic fever group,Young′s modulus AUC of the right or left renal cortex is large with high sensitivity and specificity,it is recommended to measure Young′s modulus Emean value of the renal cortex in clinical application.

关 键 词：剪切波弹性成像 流行性出血热 肾损害 

分 类 号：R512.8[医药卫生—内科学]