原发性肾小球肾炎肾脏剪切波弹性成像与肾活检病理关系研究  

Study on the relationship between renal shear wave elastography and renal biopsy pathology in primary glomerulonephritis

作　　者：郑楠 陈巧珠 吴颖仪 华洁 梁艳芳 Zheng Nan;Chen Qiaozhu;Wu Yingyi;Hua Jie;Liang Yanfang(Department of Ultrasound,Bin hai wan Central Hospital of Dongguan,Dongguan 523905,China;Department of Nephrology,Fuyang Cancer Hospital,Fuyang 2360,China;Department of Pathology Bin hai wan Central Hospital of Dongguan,Dongguan 523905,China)

机构地区：[1]东莞市滨海湾中心医院超声科,东莞523905 [2]阜阳市肿瘤医院肾内科,阜阳236000 [3]东莞市滨海湾中心医院病理科,东莞523905

出　　处：《中国医师杂志》2023年第8期1129-1133,共5页Journal of Chinese Physician

基　　金：东莞市社会发展科技项目(20211800900652);东莞市滨海湾中心医院科研项目(2020007);东莞市滨海湾中心医院科技人才科研创新基金项目(2022008);广东省基础与应用基础研究基金项目(2021B1515140066)。

摘　　要：目的探讨原发性肾小球肾炎(PGN)患者肾脏超声剪切波弹性成像(SWE)与肾活检病理的关系。方法选取2021年1月至2023年3月东莞市滨海湾中心医院收治的137例确诊PGN患者作为研究对象,行肾脏SWE定量分析及肾穿刺活检病理学检查。分析不同病理类型肾脏弹性模量的差异,肾脏弹性模量与肾活检病理因素、IgA肾病Lee分级的关系。结果IgA肾病、膜性肾病及微小病变性肾小球病是PGN最常见病理类型,三者的肾脏弹性模量差异无统计学意义(均P>0.05)。免疫复合物沉积阳性组弹性模量最大值大于阴性组(P<0.05),足细胞足突融合程度重组弹性模量平均值、中位数及最大值均小于足突融合程度轻组(均P<0.05),有系膜区嗜复红蛋白沉积组弹性模量平均值及最大值均大于无系膜区嗜复红蛋白沉积组(均P<0.05),有球囊周纤维化组弹性模量最大值小于无球囊周纤维化组(P<0.05)。61例IgA肾病各Lee分级亚组肾脏弹性模量值差异均无统计学意义(均P>0.05),Lee分级与肾脏弹性模量值不存在相关性(P>0.05)。肾脏弹性模量值与肾小球硬化率、肾小球系膜细胞和基质增生程度、肾小管萎缩面积百分率的相关性分析均无统计学意义(均P>0.05)。结论SWE有望为监测PGN病理损伤因素提供新影像诊断指标。SWE未必能高效监测IgA肾病的病理进展。Objective To explore the relationship between renal ultrasound shear wave elastography(SWE)and renal biopsy pathology in patients with primary glomerulonephritis(PGN).Methods A total of 137 confirmed PGN patients admitted to Bin hai wan Central Hospital of Dongguan from January 2021 to March 2023 were selected as the study subjects for quantitative analysis of renal SWE and pathological examination of renal biopsy.The differences in renal elastic modulus among different pathological types,as well as the relationship between renal elastic modulus and pathological factors of renal biopsy and IgA nephropathy Lee grading,were analyzed.Results IgA nephropathy,membranous nephropathy,and minimal degenerative glomerulopathy were the most common pathological types of PGN,and the difference in renal elastic modulus among the three was not statistically significant(all P>0.05).The maximum elastic modulus of the immune complex deposition positive group was greater than that of the negative group(P<0.05).The average,median,and maximum elastic modulus of the group with severe degree of foot cell fusion were lower than those of the group with mild degree of foot process fusion(all P<0.05).The average and maximum values of elastic modulus in the group with mesangial eosinophil deposition were higher than those in the group without mesangial eosinophil deposition(all P<0.05),while the maximum value of elastic modulus in the group with pericystic fibrosis was lower than that in the group without pericystic fibrosis(P<0.05).There was no statistically significant difference in the renal elastic modulus values among the Lee grading subgroups of 61 IgA nephropathy cases(all P>0.05),and there was no correlation between Lee grading and renal elastic modulus values(P>0.05).There was no statistically significant correlation analysis between the renal elastic modulus value and the glomerular sclerosis rate,the degree of mesangial cell and matrix proliferation,and the percentage of renal tubular atrophy area(all P>0.05).Conclusions SWE is e

关 键 词：肾小球肾炎 活组织检查 针吸 弹性成像技术 超声检查 

分 类 号：R692.31[医药卫生—泌尿科学]