非对比增强磁共振血管成像联合肾动态显像对动脉粥样硬化性肾动脉狭窄的诊断价值  

Diagnostic value of non-contrast-enhanced magnetic resonance angiography combined with renal dynamic imaging in atherosclerotic renal artery stenosis

作　　者：刘敏[1] 张晨 田丹丹[1] 屈慧云 郭林雅 杜慧宇 黄琦 刘芷兰 王伊菲 郝义彬 LIU Min;ZHANG Chen;TIAN Dandan;QU Huiyun;GUO Linya;DU Huiyu;HUANG Qi;LIU Zhilan;WANG Yifei;HAO Yibin(Department of Hypertension,Henan University People′s Hospital(Henan Provincial People′s Hospital),Zhengzhou 450003;Department of Clinical Medicine,Zhengzhou University,Zhengzhou 450001;Department of Clinical Medicine,Henan University of Chinese Medicine,Zhengzhou 450046;Henan University People′s Hospital(Henan Provincial People′s Hospital),Zhengzhou 450003)

机构地区：[1]河南大学人民医院(河南省人民医院)高血压科,郑州450003 [2]郑州大学临床医学系,郑州450001 [3]河南中医药大学临床医学系,郑州450046 [4]河南大学人民医院(河南省人民医院),郑州450003

出　　处：《郑州大学学报（医学版）》2024年第2期256-260,共5页Journal of Zhengzhou University(Medical Sciences)

基　　金：国家自然科学基金面上项目(82270463);河南省医学科技攻关项目(LHGJ20210025,LHGJ20220002);河南省重点研发专项(231111313400)。

摘　　要：目的:探讨非对比增强磁共振血管成像(NCE-MRA)联合肾动态显像对动脉粥样硬化性肾动脉狭窄(ARAS)的诊断价值。方法:选择2019年1月至2023年1月于河南省人民医院行肾动脉数字减影血管造影(DSA)的172例患者,按肾动脉DSA结果分为ARAS组(n=107)和非ARAS组(n=65)。比较两组患者的临床特征,分析NCE-MRA对ARAS的诊断价值,以肾动态显像测得的两侧GFR差值及比值单独或联合NCE-MRA诊断结果绘制受试者工作特征(ROC)曲线,评估对ARAS的诊断价值。结果:NCE-MRA与肾动脉DSA诊断ARAS的一致性较好(Kappa=0.828,P<0.001),NCE-MRA诊断ARAS的敏感度、特异度、准确性、阳性预测值(PPV)和阴性预测值(NPV)分别为92.52%,90.77%、91.86%、94.29%、88.06%;双肾GFR比值及差值用于诊断ARAS的AUC为0.771和0.708,最佳诊断界值为1.371和13.900 mL/(min·1.73 m^(2)),敏感度为52.3%和45.8%,特异度为90.8%和89.2%;GFR比值及差值联合NCE-MRA诊断ARAS的AUC分别为0.948和0.942,敏感度为95.3%和94.4%,特异度均为89.2%。结论:NCE-MRA对ARAS具有较高的诊断效能,联合肾动态显像可提高对ARAS的诊断价值。Aim:To explore the diagnostic value of non-contrast enhanced magnetic resonance angiography(NCE-MRA)combined with renal dynamic imaging in atherosclerotic renal artery stenosis(ARAS).Methods:A total of 172 patients who underwent renal artery digital subtraction angiography(DSA)in Henan University People′s Hospital(Henan Provincial People′s Hospital)from January 2019 to January 2023 were selected and allocated into ARAS group(n=107)and non-ARAS group(n=65).Clinical characteristics of the 2 groups and the diagnostic value of NCE-MRA for ARAS were analyzed.ROC curve was drawn with the ratio and difference of bilateral GFR measured by renal dynamic imaging and the combination of them and NCE-MRA diagnostic results to evaluate their diagnostic value for ARAS.Results:NCE-MRA and DSA were in good agreement in diagnosing ARAS(Kappa=0.828,P<0.01).The sensitivity,specificity,accuracy,positive predictive value(PPV)and negative predictive value(NPV)of NCE-MRA for diagnosing ARAS were 92.52%,90.77%,91.86%,94.29%,and 88.06%,respectively;the area under the ROC curve of the ratio and difference of bilateral GFR for diagnosing ARAS were 0.771 and 0.708,and the optimal diagnostic margins were 1.371 and 13.900 mL/(min·1.73 m^(2)),the sensitive was 52.3%and 45.8%,and the specificity was 90.8%and 89.2%.The area under the ROC curve of the ratio and difference of bilateral GFR combined with NCE-MRA for diagnosing ARAS was 0.948 and 0.942,respectively,the sensitivity was 95.3%,94.4%,the specificity was 89.2%.Conclusion:NCE-MRA has high diagnostic efficiency for ARAS.Combination with GFR measured by renal dynamic imaging can improve the diagnostic efficiency of NCE-MRA for ARAS.

关 键 词：非对比增强磁共振血管成像 肾动态显像 肾小球滤过率 动脉粥样硬化性肾动脉狭窄 诊断价值 

分 类 号：R544.1[医药卫生—心血管疾病]