超声造影评价移植肾动脉狭窄支架治疗短期疗效的临床价值  

Clinical value of contrast-enhanced ultrasound in evaluating short-term outcome of stent implantation for transplant renal artery stenosis

作　　者：戴云 徐超丽 林秀玉 孙晖 李娟[1] 宋秋怡 王晓春[1] 杨斌[1] Dai Yun;Xu Chaoli;Lin Xiuyu;Sun Hui;Li Juan;Song Qiuyi;Wang Xiaochun;Yang Bin(Department of Ultrasound Diagnostic,Jinling Hospital,School of Medicine Nanjing University,Nanjing 210002,China)

机构地区：[1]南京大学附属金陵医院(东部战区总医院)超声诊断科,江苏南京210002

出　　处：《中华医学超声杂志（电子版）》2023年第3期301-306,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：与灌注良好组比较,灌注不良组患者球囊扩张术后发生再次狭窄时间更短[(3.5±2.1)个月vs(4.8±1.6)个月]、肾动脉狭窄程度更重[(85.4±8.6)%vs(80.1±7.9)%]、狭窄长度更长[(15.5±7.4)mm vs(13.5±6.3)mm],差异具有统计学意义(t=3.457、5.452、7.746,P=0.049、0.035、0.021);支架置入术后,与灌注良好组患者相比,灌注不良组患者血肌酐值浓度更高[(325.6±115.3)μmol/L vs(212.5±103.4)μmol/L]和估算的肾小球滤过率更低[(61.8±11.7)ml/(min·1.73 m2)vs(72.5±12.4)ml/(min·1.73 m2)],肾皮质血流灌注峰值强度更低[(28.8±8.6)dB vs(33.4±10.3)dB],达峰时间更长[(24.6±7.9)s vs(20.9±6.7)s],差异均具有统计学意义(t=5.735、5.343、6.125、7.950,P=0.019、0.026、0.020、0.009)。术后随访时间为(10.5±1.6)个月,灌注不良组发生移植肾功能恶化的比例高于灌注良好组(12.0%vs 4.0%),差异具有统计学意义(χ^(2)=5.297,P=0.021)。结论超声造影可通过评估肾皮质血流灌注情况评价TRAS支架置入术后的短期疗效,其TIC参数峰值强度更低、达峰时间更长可作为TRAS行支架置入术后移植肾皮质血流灌注不良的依据,且可预测患者短期内发生移植肾功能恶化的可能性增加,可为筛选适合进行介入治疗的患者提供影像学参考依据。Objective To evaluate the clinical value of contrast-enhanced ultrasound(CEUS)in evaluating the short-term outcome of stent implantation for transplant renal artery stenosis(TRAS).Methods A total of 25 TRAS patients with stent implantation were admitted to Jinling Hospital affiliated to Nanjing University(Eastern Theater Command General Hospital)from January 2011 to December 2020.CEUS was performed 24 h after the surgery,and the time-intensity curve(TIC)was analyzed to obtain the area under curve(AUC).All patients were divided into either a poorly-perfused group(AUC≤865 dB·s;9 cases)or a well-perfused group(AUC>865 dB·s;16 cases)according to the AUC.Clinical data including age,gender,course of disease,site and degree of stenosis,blood pressure,renal function,and TIC parameters(arrival time,peak intensity,and time to peak),and postoperative renal function deterioration were compared using the independent sample t test orχ^(2) test.Results Compared with the well-perfused group,the poorly perfused group had shorter course of stenosis after balloon dilation[(3.5±2.1)months vs(4.8±1.6)months],the degree of renal artery stenosis was more severe[(85.4±8.6)%vs(80.1±7.9)%],and the stenosis was longer[(15.5±7.4)mm vs(13.5±6.3)mm];the differences were statistically significant(t=3.457,5.452,and 7.746;P=0.049,0.035,and 0.021,respectively).After stent implantation,compared with the well-perfused group,serum creatinine in the poorly perfused group was higher[(325.6±115.3)μmol/L vs(212.5±103.4)μmol/L]and estimated glomerular filtration rate was lower[(61.8±11.7)ml/(min·1.73 m2)vs(72.5±12.4)ml/(min·1.73 m2)],while cortical peak intensity was weaker[(28.8±8.6)dB vs(33.4±10.3)dB]and time to peak was longer[(24.6±7.9)s vs(20.9±6.7)s];the differences were statistically significant(t=5.735,5.343,6.125,and 7.950;P=0.019,0.026,0.020,and 0.009,respectively).The mean follow-up time was 10.5±1.6 months,and the proportion of patients in the poorly perfused group was significantly higher than that in the well-perfuse

关 键 词：移植肾动脉狭窄 支架置入术 超声造影 肾皮质血流灌注 曲线下面积 

分 类 号：R445.1[医药卫生—影像医学与核医学] R692[医药卫生—诊断学]