超声剪切波弹性成像技术无创性评价肾组织病理的探索性研究  

Exploratory study on noninvasive evaluation of renal histopathology by ultrasonic shear wave elastography

作　　者：蒲金赟 叶蕾[2] 何永华 徐荣荣 杨思莹 袁惠卿 刘思源 梁文沛 仇丽茹 Pu Jinyun;Ye Lei;He Yonghua;Xu Rongrong;Yang Siying;Yuan Huiqing;Liu Siyuan;Liang Wenpei;Qiu Liru(Department of Pediatrics,Tongji Hospital,Huazhong University of Science and Technology,Wuhan 430000,China;Department of Ultrasound Imaging,Tongji Hospital,Huazhong University of Science and Technology,Wuhan 430000,China;Department of Pediatrics,the Central Hospital of Wuhan,Wuhan 430000,China)

机构地区：[1]华中科技大学同济医学院附属同济医院儿科,武汉430000 [2]华中科技大学同济医学院附属同济医院超声影像科,武汉430000 [3]武汉市中心医院儿科,武汉430000

出　　处：《中华肾脏病杂志》2023年第8期587-594,共8页Chinese Journal of Nephrology

基　　金：湖北省科技重大专项基金(2020AEA009);湖北陈孝平科技发展基金会青年科学专项基金(CXPJJH11900018-2007);湖北省卫生健康委面上项目(WJ2023M004)。

摘　　要：目的确立慢性肾脏病(chronic kidney disease,CKD)儿童超声剪切波弹性成像(shear wave elastography,SWE)与肾组织病理改变的相关性。方法该研究为单中心横断面观察性研究,纳入2021年1—12月于华中科技大学同济医学院附属同济医院儿科住院经肾活检明确病理诊断的儿童。采用肾脏SWE技术获取肾脏上极、中部和下极的皮质、髓质区杨氏模量(YM_(皮质)、YM_(髓质))。对肾组织病理进行分级或分类,采用统计学方法分析右肾下极YM_(皮质)、YM_(髓质)与肾组织病理之间的关系。结果该研究纳入经肾活检明确病理诊断的儿童110例,年龄(10.1±3.4)岁(2~17岁),男性55例(50.0%),体重指数(20.6±2.4)kg/m^(2),平均动脉压(95±24)mmHg。CKD 1期94例(85.4%),2期和3期各有8例(7.3%)。不同分期CKD患者右肾上极和中部YM_(皮质)、YM_(髓质)以及右肾下级YM_(髓质)组间差异均无统计学意义(均P>0.05)。CKD 3期患者右肾下级YM_(皮质)[(15.75±3.36)kPa]和YM_(髓质)[(13.50±2.43)kPa]均显著高于CKD 1期患者[(12.94±2.45)kPa、(11.88±2.23)kPa](均P<0.05)。CKD 1期和2期患者右肾下极YM_(皮质)和YM_(髓质)差异均无统计学意义(均P>0.05)。新月体性肾小球肾炎患者YM_(皮质)[(17.93±3.23)kPa]、YM_(髓质)[(15.50±1.48)kPa]均高于局灶节段性肾小球硬化症[(12.71±2.42)kPa、(11.57±2.63)kPa]和系膜增生性肾小球肾炎[(12.73±2.04)kPa、(11.48±2.10)kPa]患者(均P<0.05)。局灶节段性肾小球硬化症和系膜增生性肾小球肾炎之间YM_(皮质)和YM_(髓质)差异均无统计学意义(均P>0.05)。IgA肾病Lee氏分级Ⅳ级患者YM_(皮质)[(16.30±2.63)kPa]、YM_(髓质)[(15.54±1.59)kPa]均高于Ⅲ级患者[(13.32±2.70)kPa、(12.57±2.50)kPa](均P<0.05),而紫癜性肾炎国际小儿肾脏病研究组分级与YM_(皮质)和YM_(髓质)均无明显相关性(均P>0.05)。IgA肾病和紫癜性肾炎肾小管萎缩或肾间质纤维化(T1/T2)组YM_(皮质)[(15.41±2.37)kPa]、YM_(髓质)[(13.82±2.59)Objective To determine a relationship between ultrasound shear wave elastography(SWE)and pathological lessions of renal tissues in children with chronic kidney disease(CKD).Methods It was a cross-sectional observational study,involving children admitted to the Department of Pediatrics of Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January to December 2021 with definite pathological diagnosis through kidney biopsy.The SWE was used to determine the Young's modulus(elastic modulus)of the cortex and medulla of the upper,middle,and lower poles of the kidney.The renal histopathology was classified or graded.The statistical method was used to analyze the relationship between Young's modulus of the inferior polar cortex(YM_(cor))and medulla(YM_(med))of the right kidney and renal pathology.Results The study included 110 children with definite pathological diagnosis through renal biopsy,aged(10.1±3.4)years old(2-17 years old),with 55 males(50.0%).The body mass index was(20.6±2.4)kg/m^(2),and mean arterial pressure was(95±24)mmHg.There were 94 patients(85.4%)with CKD stage 1,8 patients(7.3%)with CKD stage 2,and 8 patients(7.3%)with CKD stage 3.There was no significant difference of YM_(cor)and YM_(med)in the upper and middle poles of the right kidneys,and YM_(med)in the lower poles of right kidneys in CKD patients with different stages(all P>0.05).Both YM_(cor)[(15.75±3.36)kPa]and YM_(med)[(13.50±2.43)kPa]of CKD stage 3 patients were significantly higher than those of CKD stage 1 patients[(12.94±2.45)kPa,(11.88±2.23)kPa](both P<0.05).There was no significant difference of YM_(cor)and YM_(med)in the lower poles of right kidneys between stage 1 and stage 2 CKD patients(both P>0.05).YM_(cor)[(17.93±3.23)kPa]and YM_(med)[(15.50±1.48)kPa]in patients with crescentic glomerulonephritis were higher than those in patients with focal segmental glomerulosclerosis[(12.71±2.42)kPa,(11.57±2.63)kPa]and mesangial proliferative glomerulonephritis[(12.73±2.04)kPa,(11.48±2.10)kPa](all

关 键 词：弹性成像技术 肾功能不全 慢性 儿童 弹性模量 肾间质纤维化 

分 类 号：R726.9[医药卫生—儿科]