平面波超敏感血流显像联合剪切波弹性成像诊断慢性肾脏病的临床价值  

Clinical value of angio planewave ultrasensitive imaging combined with shear wave elastography in the diagnosis of chronic kidney disease

作　　者：刘可[1] 刘承玄[2] 牟霜[1] 黄珊珊 谢昭鹏[1] LIU Ke;LIU Chengxuan;MU Shuang;HUANG Shanshan;XIE Zhaopeng(Department of Ultrasound,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China)

机构地区：[1]重庆市中医院超声科,400021 [2]重庆市中医院肾病科,400021

出　　处：《临床超声医学杂志》2024年第1期65-69,共5页Journal of Clinical Ultrasound in Medicine

基　　金：重庆市2021年科卫联合中医药技术创新与应用发展项目(2021ZY023660)。

摘　　要：目的 探讨平面波超敏感血流显像(AP)联合剪切波弹性成像(SWE)在慢性肾脏病(CKD)诊断中的临床价值。方法 选取我院收治的CKD患者107例,根据临床分期标准分为CKD 1期组17例,CKD 2期组19例,CKD 3期组32例,CKD 4期组22例,CKD 5期组17例;另选同期健康志愿者30例为对照组。应用AP检测肾脏血流灌注情况并进行分级,SWE测量双肾中下极皮质杨氏模量平均值(Emean),比较各组上述指标的差异。分析肾脏血流灌注分级、肾皮质Emean与CKD分期的相关性;绘制受试者工作特征(ROC)曲线分析肾脏血流灌注分级、肾皮质Emean单独及联合应用对CKD的诊断效能。结果 对照组肾脏血流灌注以5级为主(60.0%),与CKD 1期组比较差异无统计学意义,与CKD 2~5期组比较差异均有统计学意义(均P<0.05);CKD 1~5期组肾脏血流灌注分级两两比较差异均有统计学意义(均P<0.05)。对照组肾皮质Emean与CKD 1期组比较差异无统计学意义,与CKD 2~5期组比较差异均有统计学意义(均P<0.05);CKD 1~5期组肾皮质Emean两两比较差异均无统计学意义。相关性分析显示,肾脏血流灌注分级与CKD分期呈负相关(r=-0.705,P<0.05),肾皮质Emean与CKD分期呈正相关(r=0.359,P<0.05)。ROC曲线分析显示,肾脏血流灌注分级、肾皮质Emean单独及联合应用诊断CKD的曲线下面积分别为0.845、0.756、0.865,二者联合应用的曲线下面积最高(均P<0.05)。结论 AP能为CKD的诊断及分期提供重要的影像学依据,SWE可评估CKD肾脏损害及程度,二者联合可进一步提高对CKD的诊断效能。Objective To explore the clinical value of angio planewave ultrasensitive imaging(AP)combined with shear wave elastography(SWE)in the diagnosis of chronic kidney disease(CKD).Methods A total of 107 patients with CKD in our hospital were selected and divided into CKD 1 with 17 patients,CKD 2 with 19 patients,CKD 3 with 32 patients,CKD 4 with 22 patients,and CKD 5 with 17 patients.Additionally,30 healthy volunteers during the same period were selected as the control group.AP was used to examine and grade the renal blood flow perfusion,SWE was used to measure the mean Young’s modulus(Emean)of the middle and lower pole cortex of both kidneys,the differences in the above indicators among each group were compared.The correlation of renal blood perfusion grading,renal cortex Emean and CKD stage were analyzed.Receiver operating characteristic(ROC)curve was drawn to analyze the renal blood perfusion grading,renal cortex Emean alone and combined application for diagnostic efficacy of CKD.Results The renal blood flow perfusion in the control group was mainly at grade 5(60.0%),there was no significant difference compared with CKD 1,while there were significantly differences compared with CKD 2~5(all P<0.05).There were significant differences in renal blood perfusion grading between any two of CKD 1~5(all P<0.05).There was no significant difference in renal cortex Emean between CKD 1 and the control group,while there were statistically significant differences compared with CKD 2~5(all P<0.05).There were no significant difference in renal cortex Emean between any two of CKD 1~5.Correlation analysis showed that renal blood perfusion grading was significantly negatively correlated with CKD stage(r=-0.705,P<0.05),and the renal cortex Emean was weakly correlated with CKD stage(r=0.359,P<0.05).ROC curve analysis showed that the area under the curve of renal blood perfusion grading,renal cortex Emean and their combination in diagnosing CKD were 0.845,0.756 and 0.865,respectively.The area under the curve of the combined application

关 键 词：超声检查 平面波超敏感血流显像 剪切波弹性成像 慢性肾脏病 血流灌注 纤维化 

分 类 号：R445.1[医药卫生—影像医学与核医学] R692.5[医药卫生—诊断学]