pCASL技术在评估合并高血压慢性肾脏疾病患者肾功能损伤和分期中的应用价值  

Application value of pCASL technique in assessing renal function impairment and staging in chronic kidney disease patients with hypertension

作　　者：罗培茵 陈秋怡 李峻枫 刘文熙 戚瑞瑞 梁秋梅 孟凡琦 王文静[3] 曾又佳[3] 陈玥瑶 LUO Peiyin;CHEN Qiuyi;LI Junfeng;LIU Wenxi;QI Ruirui;LIANG Qiumei;MENG Fanqi;WANG Wenjing;ZENG Youjia;CHEN Yueyao(Department of Radiology,The fourth Clinical Medical College of Guangzhou University of Chinese Medicine(Shenzhen Traditional Chinese Medicine Hospital),Shenzhen 518033,China;Medical AI Lab,College of Biomedical Engineering,Medical School,Shenzhen University,Shenzhen 518033,China;Department of Nephrology,The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine(Shenzhen Traditional Chinese Medicine Hospital),Shenzhen 518033,China)

机构地区：[1]广州中医药大学第四临床医学院(深圳市中医院)放射影像科,深圳518033 [2]深圳大学医学院生物医学工程学院人工智能实验室,深圳518033 [3]广州中医药大学第四临床医学院(深圳市中医院)肾病科,深圳518033

出　　处：《磁共振成像》2025年第2期65-71,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：广东省医学科研基金项目(编号:A2024660);深圳市科技计划项目(编号:JCYJ20230807094602006)。

摘　　要：目的探讨应用准连续式动脉自旋标记技术(pseudo continuous arterial spin labeling,pCASL)对有无高血压的慢性肾脏疾病(chronic kidney disease,CKD)患者肾功能损伤和分期的应用价值。材料与方法前瞻性分析20例健康志愿者(healthy volunteer,HV)、34例非高血压CKD患者(non-hypertension CKD,CN)以及36例高血压CKD患者(hypertension CKD,CH)。CKD患者又根据估计肾小球滤过率(estimation of glomerular filtration rate,eGFR)分为1~2期和3~5期患者。受检者均完成肾脏pCASL扫描,并在得到的图像上测量皮质血流灌注(renal blood flow of cortical,cRBF)值和髓质的血流灌注(renal blood flow of medullary,mRBF)值。使用配对t检验分别比较左右侧肾脏血流灌注(renal blood flow,RBF)、cRBF和mRBF值的差异。以年龄和身体质量指数(body mass index,BMI)为协变量,使用协方差(ANCOVA)分析比较不同亚组间RBF值的差异。使用受试者工作特征(receiver operating characteristic,ROC)曲线分析肾脏RBF值对肾功能损伤的诊断价值。使用Spearman相关分析评估CKD患者的肾功能指标与RBF值之间的相关性。结果左右侧肾脏的RBF值之间差异均无统计学意义(P>0.05),三组肾脏cRBF均大于mRBF(P<0.05)。HV组、CN 1~2期组和CN 3~5期组RBF值的总体差异具有统计学意义(cRBF:F=18.423,P<0.001;mRBF:F=12.026,P<0.001),进一步采用Bonferroni法进行两两组间比较结果显示,除HV组与CN 1~2的mRBF值差异不具有统计学意义(P>0.05)外,其余亚组间差异均具有统计学意义(P<0.05);HV组、CH 1~2期组和CH 3~5期组RBF值的总体差异具有统计学意义(cRBF:F=12.452,P<0.001;mRBF:F=16.153,P<0.001),HV组和CH 1~2期组的RBF值也均高于CH 3~5期组,而HV组与CH 1~2期组的RBF值差异不具有统计学意义(P>0.05)。cRBF和mRBF区分HV和CN的AUC为0.794、0.715,敏感度为52.90%、41.20%,特异度为95.00%、100.00%;而cRBF和mRBF区分HV和CH的AUC为0.740、0.726,敏感度为58.30%、47.20%,特异度为85.00%、100.00%。相Objective:To investigate the value of applying pseudo continuous arterial spin labeling(pCASL)on renal impairment and staging in chronic kidney disease(CKD)patients with or without hypertension.Materials and Methods:Twenty healthy volunteers(HV),34 non-hypertension CKD patients(CN),and 36 hypertension CKD patients(CH)were prospectively analyzed.The CKD patients were further categorized into stage 1-2 and stage 3-5 patients based on estimated glomerular filtration rate(eGFR).Subjects completed pCASL scans,and cortical and medullary renal blood flow(cRBF and mRBF)were measured.Differences in right and left side renal renal blood flow(RBF)values,cRBF and mRBF values were compared separately using paired t-tests.Adjusting for age and body mass index(BMI)as covariates,differences in RBF values between subgroups were compared using covariance(ANCOVA)test.The diagnostic value of renal RBF values for renal injury was analyzed using the receiver operating characteristic(ROC)curve.Spearman's correlation analysis was used to assess the correlation between renal function indexes and RBF values in CKD patients.Results:There was no statistically significant difference between the RBF values of the left and right side kidneys(P>0.05),and the cRBF values of the kidneys in all three groups was greater than the mRBF values(P<0.05).The overall difference in the RBF values of the HV group,the CN 1-2 stage group,and the CN 3-5 stage group was statistically significant(cRBF:F=18.423,P<0.001;mRBF:F=12.026,P<0.001),and further two-by-two intergroup comparisons using Bonferroni method showed that except the mRBF values of HV group and CN 1-2 were not statistically significant(P>0.05),the differences among other subgroups were statistically significant(P<0.05);the overall difference in RBF values between the HV,CH 1-2 and CH 3-5 stage group was also statistically significant(cRBF:F=12.452,P<0.001;mRBF:F=16.153,P<0.001).The RBF values of the HV group and the CH 1-2 stage group were also higher than those of the CH 3-5 stage group.The diffe

关 键 词：慢性肾脏疾病 高血压 准连续式动脉自旋标记技术 肾血流量 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R692[医药卫生—诊断学]