实时剪切波弹性成像技术在慢性肾病中的应用价值
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摘要
目的探讨实时剪切波弹性成像技术(SWE)在无创诊断慢性肾病(CKD)的临床价值。方法选取我院临床确诊为CKD患者200例作为观察组,并选取40例同期入院健康体检的正常健康人群为对照组,两组均使用实时剪切波弹性成像技术检测肾脏弹性模量值,检测观察组患者血肌酐(Cr)、血尿素氮(BUN)数值,并根据血肌酐数值进行CKD分期。比较两组人员左肾中下极肾皮质和肾窦及肾髓质的杨氏模量值,并比较不同CKD分期中不同左肾中下极肾实质杨氏模量值的差异。结果观察组患者左肾中下极肾皮质和和肾窦及肾髓质明显高于对照组,差异有统计学意义(P<0.05);观察组患者左肾中下极各个区域杨氏模量值相比,差异有统计学意义(P<0.05);对照组左肾中下极肾窦部杨氏模量值明显低于皮质及髓质杨氏模量值,差异有统计学意义(P<0.05)。CKD1期患者与CKD2期患者左肾中下极各个区域杨氏模量值比较,差异无统计学意义(t=1.21,P=0.22);其余各期左肾中下极各个区域杨氏模量值比较,差异有统计学意义(P<0.05)。随着慢性肾病患者病情的加重,其肾皮质和肾髓质区域杨氏模量值也会逐渐增加,差异有统计学意义(P<0.05)。观察组Cr、BUN、UA较对照组明显增高,差异有统计学意义(P<0.05)。结论临床采用实时剪切波弹性成像技术检测慢性肾病患者可更好地判断患者肾脏弹性模量值,同时通过观察患者血液生化指标,有助于临床疾病无创诊断和病情判断。
Objective To investigate the clinical value of real-time shear wave elastography(SWE) in non-invasive diagnosis of chronic kidney disease(CKD). Methods A total of 200 patients with CKD clinically diagnosed in our hospital were enrolled as the observation group. 40 normal healthy people who were admitted in the hospital for physical examination were selected as the control group. The real-time shear wave elastography was used in two groups to detect the value of elastic modulus of the kidney. Serum creatinine(Cr) and blood urea nitrogen(BUN) values in the observation group were measured, and CKD staging was performed according to the serum creatinine value. The Young's modulus values of the renal cortex and sinus and renal medulla in the left middle and lower poles of the two groups were compared. And the differences in Young's modulus of left middle and lower poles of left kidney in different CKD stages were compared. Results The Young's modulus of cortex, sinuses and medulla of the left kidney were significantly higher in the observation group than those in the control group(P<0.05). There was significant difference in the Young's modulus values between the middle and lower poles of left kidney in the observation group(P<0.05). In the control group, the Young's modulus value of the left kidney middle-lower pole sinus was significantly lower than that of the cortex and the medulla(P<0.05). There was no significant difference in the Young's modulus of the middle and lower poles of the left kidney between the CKD stage 1 and the CKD stage 2 patients(t=1.21, P=0.22). The difference in modulus values among the different regions of middle and lower poles at the remaining stages was statistically significant(P<0.05). As the condition of patients with chronic kidney disease worsened, the Young's modulus values in the renal cortex and medulla gradually increased(P<0.05). Cr, BUN and UA was significantly higher than that of the control group(P<0.05).Conclusion The clinical use of real-time shear wave elastography in the detection of patients with chronic kidney disease can better determine the renal elastic modulus value, and at the same time, the observation of blood biochemical indicators is helpful for non-invasive diagnosis and disease judgment of clinical diseases.
Objective To investigate the clinical value of real-time shear wave elastography(SWE) in non-invasive diagnosis of chronic kidney disease(CKD). Methods A total of 200 patients with CKD clinically diagnosed in our hospital were enrolled as the observation group. 40 normal healthy people who were admitted in the hospital for physical examination were selected as the control group. The real-time shear wave elastography was used in two groups to detect the value of elastic modulus of the kidney. Serum creatinine(Cr) and blood urea nitrogen(BUN) values in the observation group were measured, and CKD staging was performed according to the serum creatinine value. The Young's modulus values of the renal cortex and sinus and renal medulla in the left middle and lower poles of the two groups were compared. And the differences in Young's modulus of left middle and lower poles of left kidney in different CKD stages were compared. Results The Young's modulus of cortex, sinuses and medulla of the left kidney were significantly higher in the observation group than those in the control group(P<0.05). There was significant difference in the Young's modulus values between the middle and lower poles of left kidney in the observation group(P<0.05). In the control group, the Young's modulus value of the left kidney middle-lower pole sinus was significantly lower than that of the cortex and the medulla(P<0.05). There was no significant difference in the Young's modulus of the middle and lower poles of the left kidney between the CKD stage 1 and the CKD stage 2 patients(t=1.21, P=0.22). The difference in modulus values among the different regions of middle and lower poles at the remaining stages was statistically significant(P<0.05). As the condition of patients with chronic kidney disease worsened, the Young's modulus values in the renal cortex and medulla gradually increased(P<0.05). Cr, BUN and UA was significantly higher than that of the control group(P<0.05).Conclusion The clinical use of real-time shear wave elastography in the detection of patients with chronic kidney disease can better determine the renal elastic modulus value, and at the same time, the observation of blood biochemical indicators is helpful for non-invasive diagnosis and disease judgment of clinical diseases.
引文
[1]郑剑,刘勇,郑荣琴,等.实时二维剪切波弹性成像与实时组织弹性成像评估慢性肝病肝纤维化的比较研究[J]中华超声影像学杂志,2014,23(11):944-947.
[2]杨道玲,韦嘉,张勇,等.实时剪切波超声弹性成像对健康成人肝组织硬度定量分析研究[J].中国超声医学杂志,2014,30(5):411-414.
[3]曾庆劲,曾婕,郑荣琴,等.剪切波弹性成像在乳腺实性病变良恶性鉴别诊断中的价值[J].中华超声影像学杂志,2014,23(2):129-132.
[4]张茜茜,王倩,艾红,等.剪切波弹性成像在弥漫性甲状腺疾病中的应用[J].中华超声影像学杂志,2014,23(6):489-492.
[5]吴昊,陈琴,周青,等.评价剪切波弹性成像结合超声造影对甲状腺TI-RADS3、4类结节的鉴别诊断价值[J]中国超声医学杂志,2015,31(8):676-679.
[6]刘保娴,梁瑾瑜,谢晓燕,等.应用Logistic回归模型评价剪切波弹性成像在甲状腺结节鉴别诊断中的价值[J]中华超声影像学杂志,2014,23(8):671-674.
[7]李娜,符叶柳.经直肠剪切波弹性成像联合磁共振波谱诊断前列腺癌的价值[J].重庆医学,2015,44(19):2659-2661.
[8]王金环,于国英,徐辉雄,等.实时剪切波弹性成像检测的肝脏硬度与食管静脉曲张程度的相关性[J].中华肝脏病杂志,2015,23(7):502-506.
[9]张琼珍.超声实时剪切波弹性成像与组织弹性成像技术对早期乳腺癌的鉴别诊断价值[J].实用医学杂志,2017,33(3):417-420.
[10]宋毅,程敬亮,张瑞芳,等.实时剪切波弹性成像检测肝局灶性占位性病变的影响因素分析[J].中华超声影像学杂志,2016,25(7):589-592.
[11]陈雅玲,高毅,王芬,等.乳腺剪切波弹性成像的各向异性与组织病理学的相关性[J].中华超声影像学杂志,2017,26(3):254-258.
[12]黄韵琳,薛恩生,俞丽云,等.实时剪切波弹性成像影响因素的实验研究[J].中华超声影像学杂志,2016,25(12):1076-1080.
[13]张鑫鑫,李士星,鞠浩,等.剪切波和实时组织超声弹性成像对BA和IHS肝弹性改变探讨[J].中国超声医学杂志,2016,32(9):808-811.
[14]李晔,王知力.乳腺导管内乳头状瘤:剪切波弹性成像评价乳腺病变良恶性误诊的潜在原因[J].中国医学影像学杂志,2015,23(12):896-899,904.
[15]丁洋,安子英,王岁晶,等.肝脏实时剪切波弹性成像和超声量化评分评价恩替卡韦治疗慢性乙型肝炎肝纤维化疗效的研究[J].中国临床医学影像杂志,2016,27(6):407-410.
[16]王倩,艾红,张茜茜,等.剪切波弹性成像技术定量评估慢性肾病分期的应用价值[J].中华超声影像学杂志,2014,23(5):414-418.
[17]李芸.生化指标联合检测诊断糖尿病早期肾脏损伤的价值[J].中国城乡企业卫生,2017,32(7):37-39.
[18]李娟红,赵子贤,李珍瑶,等.4项生化指标检测在多发性骨髓瘤患者早期肾伤害的诊断价值[J].国际检验医学杂志,2016,37(9):1188-1189.
[19]周华强,白志杨,伍尚华.CysC、RBP、BUN和Cr联合检测早期诊断肾脏疾病的意义研究[J].中国当代医药,2016,23(23):129-131.
[20]王琛,顾志峰,王朔,等.前列地尔联合肾康注射液对慢性肾炎患者尿蛋白、肾功能及血清炎性因子水平的影响[J].海南医学院学报,2016,22(19):2276-2279.
[21]杨志,张骥,唐立萍.早期糖尿病肾病患者血清RBP、NEFA、FKN含量与尿蛋白排泄及肾小球滤过功能损伤的关系[J].海南医学院学报,2016,22(23):2822-2825.
[2]杨道玲,韦嘉,张勇,等.实时剪切波超声弹性成像对健康成人肝组织硬度定量分析研究[J].中国超声医学杂志,2014,30(5):411-414.
[3]曾庆劲,曾婕,郑荣琴,等.剪切波弹性成像在乳腺实性病变良恶性鉴别诊断中的价值[J].中华超声影像学杂志,2014,23(2):129-132.
[4]张茜茜,王倩,艾红,等.剪切波弹性成像在弥漫性甲状腺疾病中的应用[J].中华超声影像学杂志,2014,23(6):489-492.
[5]吴昊,陈琴,周青,等.评价剪切波弹性成像结合超声造影对甲状腺TI-RADS3、4类结节的鉴别诊断价值[J]中国超声医学杂志,2015,31(8):676-679.
[6]刘保娴,梁瑾瑜,谢晓燕,等.应用Logistic回归模型评价剪切波弹性成像在甲状腺结节鉴别诊断中的价值[J]中华超声影像学杂志,2014,23(8):671-674.
[7]李娜,符叶柳.经直肠剪切波弹性成像联合磁共振波谱诊断前列腺癌的价值[J].重庆医学,2015,44(19):2659-2661.
[8]王金环,于国英,徐辉雄,等.实时剪切波弹性成像检测的肝脏硬度与食管静脉曲张程度的相关性[J].中华肝脏病杂志,2015,23(7):502-506.
[9]张琼珍.超声实时剪切波弹性成像与组织弹性成像技术对早期乳腺癌的鉴别诊断价值[J].实用医学杂志,2017,33(3):417-420.
[10]宋毅,程敬亮,张瑞芳,等.实时剪切波弹性成像检测肝局灶性占位性病变的影响因素分析[J].中华超声影像学杂志,2016,25(7):589-592.
[11]陈雅玲,高毅,王芬,等.乳腺剪切波弹性成像的各向异性与组织病理学的相关性[J].中华超声影像学杂志,2017,26(3):254-258.
[12]黄韵琳,薛恩生,俞丽云,等.实时剪切波弹性成像影响因素的实验研究[J].中华超声影像学杂志,2016,25(12):1076-1080.
[13]张鑫鑫,李士星,鞠浩,等.剪切波和实时组织超声弹性成像对BA和IHS肝弹性改变探讨[J].中国超声医学杂志,2016,32(9):808-811.
[14]李晔,王知力.乳腺导管内乳头状瘤:剪切波弹性成像评价乳腺病变良恶性误诊的潜在原因[J].中国医学影像学杂志,2015,23(12):896-899,904.
[15]丁洋,安子英,王岁晶,等.肝脏实时剪切波弹性成像和超声量化评分评价恩替卡韦治疗慢性乙型肝炎肝纤维化疗效的研究[J].中国临床医学影像杂志,2016,27(6):407-410.
[16]王倩,艾红,张茜茜,等.剪切波弹性成像技术定量评估慢性肾病分期的应用价值[J].中华超声影像学杂志,2014,23(5):414-418.
[17]李芸.生化指标联合检测诊断糖尿病早期肾脏损伤的价值[J].中国城乡企业卫生,2017,32(7):37-39.
[18]李娟红,赵子贤,李珍瑶,等.4项生化指标检测在多发性骨髓瘤患者早期肾伤害的诊断价值[J].国际检验医学杂志,2016,37(9):1188-1189.
[19]周华强,白志杨,伍尚华.CysC、RBP、BUN和Cr联合检测早期诊断肾脏疾病的意义研究[J].中国当代医药,2016,23(23):129-131.
[20]王琛,顾志峰,王朔,等.前列地尔联合肾康注射液对慢性肾炎患者尿蛋白、肾功能及血清炎性因子水平的影响[J].海南医学院学报,2016,22(19):2276-2279.
[21]杨志,张骥,唐立萍.早期糖尿病肾病患者血清RBP、NEFA、FKN含量与尿蛋白排泄及肾小球滤过功能损伤的关系[J].海南医学院学报,2016,22(23):2822-2825.