应用多参数超声评估慢性肾脏疾病肾纤维化的初步探索  

Preliminary exploration of the application of multi-parameter ultrasound in the assessment of chronic kidney fibrosis

作　　者：张瑶 黄星月[1] 邓倾[1] 陈婷 黄鑫[1] 张隽 胡玉刚 周青[1] Zhang Yao;Huang Xingyue;Deng Qing;Chen Ting;Huang Xin;Zhang Jun;Hu Yugang;Zhou Qing(Department of Ultrasound Imaging,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院超声影像科,武汉430060

出　　处：《中华超声影像学杂志》2025年第1期65-73,共9页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(82271999)。

摘　　要：目的探讨多参数超声在无创诊断慢性肾脏疾病(CKD)患者肾纤维化程度中的应用价值。方法前瞻性收集2023年12月至2024年4月于武汉大学人民医院就诊的77例CKD患者(CKD组)及30例体检健康者(对照组)。CKD组根据病理学肾纤维化程度分为轻度(n=30)、中度(n=25)及重度(n=22)组,获取所有受检者超声参数及临床资料并进行组间比较。将单因素分析中差异有统计学意义的超声参数纳入Logistic回归模型中分析独立影响因素,绘制ROC曲线并计算曲线下面积(AUC)。结果①中度、重度组与对照组相比,重度组与轻度、中度组相比,SCr、BUN升高,eGFR降低,差异有统计学意义(均P<0.05);中度组肾脏长径、肾实质厚度小于对照组,重度组肾脏长径、肾实质厚度、肾皮质厚度小于对照组、轻度组、中度组,差异有统计学意义(均P<0.05);重度组Vmax低于对照组、轻度组与中度组,RI高于对照组、轻度组与中度组,差异有统计学意义(均P<0.05)。②超微血流成像(SMI)下血流灌注分级对照组及轻度组均以5级为主(83.33%,25/30;70.00%,21/30),中度组以4级为主(48.00%,12/25),重度组以3级为主(63.64%,14/22);轻度组与对照组、中度组与重度组组间分级差异无统计学意义(均P>0.05),余各组间差异均有统计学意义(P<0.05)。③剪切波弹性成像及超分辨率成像显示轻度组、中度组及重度组肾脏皮质区杨氏模量平均值(Emean)逐渐变大,微血管密度逐渐减少,除Emean在中度组与重度组组间差异无明显统计学意义外(P>0.05),其他各组间差异均有统计学意义(P<0.05)。④ROC曲线分析显示Emean、微血管密度联合诊断鉴别对照组与轻度组的AUC为0.769(95%CI=0.631~0.872,P<0.001),敏感度为0.821,特异度为0.539;Emean、微血管密度、段间动脉峰值流速(Vmax)及阻力指数(RI)多参数联合诊断鉴别轻度与中重度组的AUC为0.902(95%CI=0.843~0.972,P<0.001),敏感度为0.967,特异度为0.755,上述多�ObjectiveTo investigate the application value of multi-parameter ultrasound in the non-invasive assessment of renal fibrosis in patients with chronic kidney disease(CKD).MethodsFrom December 2023 to April 2024,77 CKD patients(CKD group)and 30 healthy individuals(control group)from Renmin Hospital of Wuhan University were prospectively collected.The CKD group was further classified into mild(n=30),moderate(n=25)and severe(n=22)groups according to pathological assessment of renal fibrosis.Ultrasound parameters and clinical data of all patients were collected for group comparisons.Ultrasound parameters that showed statistically significant differences in univariate analysis were incorporated into a Logistic regression model to identify independent influencing factors.ROC curve was constructed,and the area under the curve(AUC)was calculated for statistical evaluation.Results①The moderate and severe groups compared to control group,as well as the severe group compared to the mild and moderate groups,showed increased levels of SCr and BUN,and decreased level of eGFR,with statistically significant differences(all P<0.05).The kidney length and renal parenchymal thickness in the moderate group were smaller than those in the control group,while the kidney length,renal parenchymal thickness,and renal cortical thickness in the severe group were smaller than those in the control,mild,and moderate groups,with statistically significant differences among the groups(all P<0.05).The Vmax in the severe group was lower than those in the control,mild,and moderate groups,while the RI was higher than those in the control,mild,and moderate groups,with statistically significant differences(all P<0.05).②In superb microvascular imaging,perfusion levels were predominantly grade 5 in the control and mild groups(83.3%,25/30;70.0%,21/30),grade 4 in the moderate group(48.0%,12/25),and grade 3 in the severe group(63.6%,14/22).No significant differences were observed between the mild and control groups,or between the moderate and severe group

关 键 词：多参数超声 肾纤维化 超分辨率成像 剪切波弹性成像 

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]