常规超声联合超声造影定量评价移植肾血流灌注对生存预后的预测价值  

Predictive value of conventional ultrasoundcombined with quantitative parameters of contrast-enhanced ultrasound in evaluating kidney perfusion for predicting survival outcomes of patients after kidney transplantation

作　　者：戴云[1] 徐超丽 宋秋怡 孙晖[1] 林秀玉 谢迎东[1] 杨斌[1] DAI Yun;XU Chao-li;SONG Qiu-yi;SUN Hui;LIN Xiu-yu;XIE Ying-dong;YANG Bin(Department of Ultrasound Diagnostic,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jian-gsu,China;Department of Ultrasound,First Affiliated Hospital of Nanjing Medical University,Jiangsu Provincial People’s Hospital,Nanjing 210029,Jiangsu,China)

机构地区：[1]东部战区总医院(原南京军区南京总医院)超声诊断科,南京210002 [2]南京医科大学第一附属医院超声科,南京210029

出　　处：《东南国防医药》2022年第6期596-601,共6页Military Medical Journal of Southeast China

摘　　要：目的探讨常规超声联合超声造影(CEUS)定量参数评估移植术后早期移植肾血流灌注状态预测移植肾生存预后的临床价值。方法回顾性分析2010年1月至2020年12月东部战区总医院行肾移植术患者133例的临床资料。所有患者术后5~14 d、3个月行常规超声及CEUS检查。以血肌酐较术后5~14 d升高50%以上,或进展到移植肾失功需要血透维持为终点事件,随访患者移植肾生存时间。将血肌酐较移植术后升高50%以上的患者定义为肌酐升高组,反之为肌酐正常组。使用单因素Kaplan-Meier方法(非参数Log-rank检验)及多因素Cox比例风险模型比较2组患者年龄、肾功能(血肌酐、尿酸、尿素氮、eGFR)、肾各级动脉血流阻力指数(RI)、定量CEUS参数包括皮质始增时间(AT)、达峰时间(TTP)以及达峰强度(PI)、曲线下面积(AUC_(TIC))等参数之间生存时间的差异。结果研究人群随访移植肾生存时间3~112.8个月,中位数随访时间12.9个月,平均随访时间为(16.76±24.84)个月。单因素Kaplan-Meier(Log-rank)检验及Cox多因素生存分析模型分析结果显示患者移植术后5~14 d期间叶间动脉RI(OR 3.765,95%CI 1.162~11.539,P=0.016)、PI(OR5.053,95%CI 1.123~22.535,P=0.032)、AUC_(TIC)(OR 8.955,95%CI 1.080~74.227,P=0.042)及移植术后3个月叶间动脉RI(OR 7.392,95%CI 2.401~22.754,P=0.000)均与患者生存预后相关。结论常规超声叶间动脉RI联合CEUS定量参数PI、AUC_(TIC)在移植术后3个月内评估移植肾血流微循环灌注状态可用于预测患者生存预后,有助于指导临床对患者及早采取防治措施。Objective This study aims to investigate thepredictive value of conventional ultrasound combined with quantitative parameters of contrast-enhanced ultrasound(CEUS)in evaluating the blood perfusion status of transplanted kidney to predict the survival prognosis of transplanted kidney.Methods A total of 133 patients receiving kidney transplantation in Eastern Theater Command General Hospital from January 2010 to December 2020 were retrospectively analyzed.All patients underwent conventional ultrasound and CEUS examination during 5-14 days after transplantation.The primary end point of the study was defined as serum creatinine increased by more than 50%compared with 5-14 days,3 months after transplantation or progressed to renal graft loss requiring hemodialysis maintenance.The survival time of the transplant kidney was record.The serum creatinine increased group was defined as serum creatinine increased by more than 50%,vise versa as serum creatinine normal group.Univariate Kaplan-Meier method with non-parametric log-rank test and multivariate Cox proportional risk model were used for comparing the differences of survival time in age,renal function(serum creatinine,uric acid,urea nitrogen,eGFR),renal arterials’resistance index(RI)and quantitative CEUS parameters,including cortical initiation time(AT),time to peak(TTP),peak intensity(PI),area under the curve(AUC_(TIC)).Results The survival time of the study population after transplantation was 3-112.8 months,the median follow-up time was 12.9 months,and the mean follow-up time was(16.76±24.84)months.Univariate Kaplan-Meier(Log-rank)test analysis and Cox multivariate survival analysis model showed that interlobular artery RI(OR 3.765,95%CI 1.162-11.539,P=0.016),PI(OR5.053,95%CI 1.123-22.535,P=0.032),AUC_(TIC)(OR 8.955,95%CI 1.080-74.227,P=0.042)in 5-14 days after transplantation and interlobular artery RI(OR 7.392,95%CI 2.401-22.754,P=0.000)in 3 months after transplantation were independently correlated with survival outcomes.Conclusion Early interlobular artery R

关 键 词：超声造影 移植肾 生存期 达峰强度 

分 类 号：R445.1[医药卫生—影像医学与核医学] R699.2[医药卫生—诊断学]