超声联合血栓调节蛋白检测对移植肾急性排斥反应与急性肾小管间质性肾炎的鉴别分析  

Differential analysis of ultrasound combined with thrombomodulin detection for acute rejection of transplanted kidneys and acute tubulointerstitial nephritis

作　　者：龙妹珍 刘地宽 陈锋[1] 刘馨蔚 陈思凡 LONG Meizhen;LIU Dikuan;CHEN Feng;LIU Xinwei;CHEN Sifan(Department of Ultrasound,Yiyang Central Hospital Affiliated to Hunan University of Chinese Medicine,Hunan,Yiyang 413000,China;Department of Kidney Transplantation,Yiyang Central Hospital Affiliated to Hunan University of Chinese Medicine,Hunan,Yiyang 413000,China)

机构地区：[1]湖南中医药大学附属益阳中心医院超声科,湖南益阳413000 [2]湖南中医药大学附属益阳中心医院肾移植科,湖南益阳413000

出　　处：《中国医药科学》2025年第4期13-18,27,共7页China Medicine And Pharmacy

基　　金：湖南省自然科学基金项目(2023JJ50358)。

摘　　要：目的探讨超声(US)联合血栓调节蛋白(TM)检测对移植肾急性排斥反应(AR)的诊断以及对AR和急性肾小管间质性肾炎(ATIN)的鉴别诊断价值。方法选择2023年3月至2024年7月在湖南中医药大学附属益阳中心医院超声科和肾移植科随访的59例肾移植患者(肾移植术后≥1个月),其中正常组29例,AR组16例,ATIN组14例,所有纳入对象均在治疗前行常规US、超声造影(CEUS)及TM检测,分析不同参数在正常组、AR组和ATIN组患者中是否具有统计学意义。结果AR组与正常组比较:AR组TM更高,弓形动脉阻力指数(RIaa)、段动脉阻力指数(RIsa)升高,弓形动脉收缩期峰值流速(PSVaa)、叶间动脉收缩期峰值流速(PSVia)减低,皮质曲线下面积(AUCc)、髓质曲线下面积(AUCm)显著降低。ATIN组与正常组比较:TM无统计学意义,ATIN的RIaa可能高于正常组,AUCc、AUCm低于正常组。AR组与ATIN组比较:AR组的TM高于ATIN组。TM与US联合诊断AR的AUC:0.940(95%CI:0.877,1.000,P<0.001),最大约登指数0.766,敏感度为81.3%,特异度为95.3%,鉴别诊断AR和ATIN的AUC:0.926(95%CI:0.838,1.000,P<0.001),敏感度为68.8%,特异度为100.0%。结论TM和US可用于评估诊断移植肾AR,且TM与US联合可以进一步鉴别移植肾AR和ATIN。Objective To investigate the diagnosis of ultrasound(US)combined with thrombomodulin(TM)detection for acute rejection(AR)of transplanted kidneys and its differential diagnosis value between AR and acute tubulointerstitial nephritis(ATIN).Methods A total of 59 kidney transplant patients(no less than 1 month after kidney transplantation)who were followed up in the Departments of Ultrasound and Kidney Transplantation of Yiyang Central Hospital Affiliated to Hunan University of Chinese Medicine from March 2023 to July 2024 were included,and they were divided into the control group(n=29),the AR group(n=16),and the ATIN group(n=14).All participants underwent conventional US,contrast-enhanced ultrasound(CEUS),and TM testing before treatment to analyze whether there were statistically significant differences in different parameters of patients in the control group,the AR group,and the ATIN group.Results Compared with the control group,the AR group had higher TM,increased resistance indices of the arcuate artery(RIaa)and segmental artery(RIsa),decreased peak systolic velocities of the arcuate artery(PSVaa)and interlobar artery(PSVia),and significantly decreased areas under the cortical curve(AUCc)and medullary curve(AUCm).Compared with the control group,there was no statistically significant difference in TM between the ATIN group and the control group.The RIaa of the ATIN group might be higher than that of the control group,while the AUCc and AUCm were lower than those of the control group.Compared with the ATIN group,the TM of the AR group was higher than that of the ATIN group.The AUC for the combined diagnosis of AR using TM and US was 0.940(95%CI:0.877,1.000,P<0.001),with a maximum Jordan index of 0.766,sensitivity of 81.3%,and specificity of 95.3%.The AUC for the differential diagnosis of AR and ATIN was 0.926(95%CI:0.838,1.000,P<0.001),with a sensitivity of 68.8%,and specificity of 100.0%.Conclusion TM and US can be used to evaluate and diagnose AR in transplanted kidneys,and the combination of TM and US can furthe

关 键 词：移植肾 急性排斥反应 急性肾小管间质性肾炎 超声 超声造影 血栓调节蛋白 

分 类 号：R445.1[医药卫生—影像医学与核医学] R669.2[医药卫生—诊断学]