声辐射力脉冲弹性成像联合肾功能定量评估胡桃夹综合征患者肾实质硬度
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摘要
目的探讨声辐射力脉冲成像(ARFI)定量评估胡桃夹综合征(NS)患者肾实质硬度的效果。方法选取该院54例NS患者作为NS组,另选取40例健康青年作为对照组;采用常规超声测量左肾静脉跨腹主动脉狭窄段(a)和近肾门段(b)内径及其血流峰值流速(Va,Vb);采用ARFI测量双侧肾实质硬度获得剪切波速度(SWV)值;采用t检验分析2组患者各测量值的差异;采用Spearman相关性分析肾实质SWV测量值与患者年龄、体重指数(BMI)、血肌酐等相关性。结果 NS组LRV狭窄段内径(a)显著小于对照组(仰卧位、后伸位),b/a(仰卧位、后伸位)显著大于对照组,差异均有统计学意义(P<0.05)。2组仰卧位Va(仰卧位、后伸位)、Va/Vb(仰卧位、后伸位)比较差异均有统计学意义(P<0.05)。NS组左肾SWV值显著低于右肾,差异有统计学意义(P<0.05)。NS组左肾SWV值与GFR、肌酐(Cr)、静脉直径比值、静脉血流比值均无显著相关性(P>0.05),而与BMI呈正相关(P<0.05),与b/a(仰卧位、后伸位)、血流速度比值Va/Vb(仰卧位、后伸位)、左肾段动脉阻力指数呈负相关(P<0.05)。结论 ARFI是一种在评估NS患者肾实质改变方面全新、可增加诊断信息的方法。SWV降低、左肾静脉狭窄处峰值流速显著升高可作为诊断NS阳性的参考指标。
Objective To investigate the effect of acoustic radiation pulse imaging(ARFI)on the quantitative determination of renal parenchyma hardness in patients with nutcracker syndrome(NS).Methods 54 cases of NS patients in the hospital were selected as the NS group,and 40 healthy young people were selected as the control group.The diameter of the left renal vein across the abdominal aortic stenosis(a)and the proximal renal segment(b)and its peak flow velocity(Va,Vb)were measured using conventional ultrasound.SWV values were obtained by measuring the bilateral renal parenchyma hardness using ARFI.The difference between the measured values of the two groups of patients was analyzed by t test.Spearman correlation was used to analyze the correlation between SWV measurements of renal parenchyma and patients′age,body mass index(BMI)and serum creatinine.Results The inner diameter(a)of the LRV stenosis group in the NS group was significantly smaller than that in the control group(supine position,posterior extension position),b/a(supine position,posterior extension position)was significantly greater than the control group,and the difference was statistically significant(P <0.05).There were statistically significant differences between the two groups in the supine position Va(supine position,posterior extension position)and Va/Vb(supine position,posterior extension position)(P<0.05).The SWV value of the left kidney in the NS group was significantly lower than that in the right kidney,and the difference was statistically significant(P<0.05).There was no significant correlation between SWV value of left kidney and GFR,creatinine(Cr),venous diameter ratio,and venous blood flow ratio in NS group(P>0.05).The SWV value of left kidney in NS group was positively correlated with BMI(P<0.05),and b/a(supine position,posterior extension position),blood flow velocity ratio Va/Vb(supine position,posterior extension position),left kidney segment The arterial resistance index was negatively correlated(P<0.05).Conclusion ARFI is a new method for assessing renal parenchymal changes in NS patients.A significant increase in SWV and a significant increase in the peak flow velocity at the left renal vein stenosis can be used as a reference for the diagnosis of NS positivity.
Objective To investigate the effect of acoustic radiation pulse imaging(ARFI)on the quantitative determination of renal parenchyma hardness in patients with nutcracker syndrome(NS).Methods 54 cases of NS patients in the hospital were selected as the NS group,and 40 healthy young people were selected as the control group.The diameter of the left renal vein across the abdominal aortic stenosis(a)and the proximal renal segment(b)and its peak flow velocity(Va,Vb)were measured using conventional ultrasound.SWV values were obtained by measuring the bilateral renal parenchyma hardness using ARFI.The difference between the measured values of the two groups of patients was analyzed by t test.Spearman correlation was used to analyze the correlation between SWV measurements of renal parenchyma and patients′age,body mass index(BMI)and serum creatinine.Results The inner diameter(a)of the LRV stenosis group in the NS group was significantly smaller than that in the control group(supine position,posterior extension position),b/a(supine position,posterior extension position)was significantly greater than the control group,and the difference was statistically significant(P <0.05).There were statistically significant differences between the two groups in the supine position Va(supine position,posterior extension position)and Va/Vb(supine position,posterior extension position)(P<0.05).The SWV value of the left kidney in the NS group was significantly lower than that in the right kidney,and the difference was statistically significant(P<0.05).There was no significant correlation between SWV value of left kidney and GFR,creatinine(Cr),venous diameter ratio,and venous blood flow ratio in NS group(P>0.05).The SWV value of left kidney in NS group was positively correlated with BMI(P<0.05),and b/a(supine position,posterior extension position),blood flow velocity ratio Va/Vb(supine position,posterior extension position),left kidney segment The arterial resistance index was negatively correlated(P<0.05).Conclusion ARFI is a new method for assessing renal parenchymal changes in NS patients.A significant increase in SWV and a significant increase in the peak flow velocity at the left renal vein stenosis can be used as a reference for the diagnosis of NS positivity.
引文
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[12]芮志凤,蔡峰,张虎军.声脉冲辐射力成像与慢性肾脏疾病分期和估算肾小球滤过率的相关性研究[J].成都医学院学报,2017,12(3):316-320.
[13]王慧芬,张周龙,李新.声脉冲辐射力成像技术对慢性肾病分期的诊断价值[J].东南大学学报(医学版),2017,36(5):717-722.
[14]陈安萌,何岩莉,张婉君,等.声脉冲辐射力成像在慢性肾脏病纤维化程度研究中的应用[J].中国中西医结合影像学杂志,2017,15(2):183-185.
[15]王惠,南彩玲,姚亚宁,等.声脉冲辐射力成像对过敏性紫癜性肾炎定量诊断的临床价值[J].兰州大学学报(医学版),2016,42(5):26-30.
[2]任虹蓉,张爱平,姜晓宇,等.胡桃夹综合征合并肾小球疾病患者临床与病理分析[J].临床误诊误治,2016,29(4):79-83.
[3]卜凡文,陈慧霞,姜莉.胡桃夹综合征合并肾脏器质性病变的超声诊断与临床研究[J].中国中西医结合影像学杂志,2015,13(5):518-520.
[4]杨荣,李梅.超声诊断胡桃夹综合征继发盆腔充血综合征1例[J].临床超声医学杂志,2014,16(1):33-34.
[5]张英根,林惠芳,李佳,等.超声诊断儿童胡桃夹现象200例的临床研究及观察血流动力学的价值[J].实用医技杂志,2017,24(8):835-837.
[6]杜联芳,贾亚薇,苏一巾.三种超声方法评价左肾静脉受压综合症的价值[J].上海医学影像,2006,15(2):129-131.
[7] SHIN JI,PARK JM,LEE JS,et al.Effect of renal Doppler ultrasound on the detection of Nutcracker syndrome in children with hematuria[J].Eur J Pediatr,2007,166(5):399-404.
[8] BOTA S,BOB F,SPOREA I,et al.Factors that influence kidney shear wave speed assessed by acoustic radiation force impulse elastography in patients without kidney pathology[J].Ultrasound Med Biol,2015,41(1):1-6.
[9] GOYA C,DAGGULLI M,HAMIDI C,et al.The role of quantitative measurement by acoustic radiation force impulse imaging in differentiating benign renal lesions from malignant renal tumours[J].Radiologia Medica,2015,120(3):296-303.
[10]BEKCI T,CEYHAN BILGICI M,GENC G,et al.Evaluation of renal parenchyma elasticity with acoustic radiation force impulse quantification in Nutcracker syndrome and comparisons with grayscale doppler sonography and laboratory findings[J].J Ultrasound Med,2017,36(1):61-67.
[11]GOYA C,HAMIDI C,ECE A,et al.Acoustic radiation force impulse(ARFI)elastography for detection of renal damage in children[J].Pediatr Radiol,2015,45(1):55-61.
[12]芮志凤,蔡峰,张虎军.声脉冲辐射力成像与慢性肾脏疾病分期和估算肾小球滤过率的相关性研究[J].成都医学院学报,2017,12(3):316-320.
[13]王慧芬,张周龙,李新.声脉冲辐射力成像技术对慢性肾病分期的诊断价值[J].东南大学学报(医学版),2017,36(5):717-722.
[14]陈安萌,何岩莉,张婉君,等.声脉冲辐射力成像在慢性肾脏病纤维化程度研究中的应用[J].中国中西医结合影像学杂志,2017,15(2):183-185.
[15]王惠,南彩玲,姚亚宁,等.声脉冲辐射力成像对过敏性紫癜性肾炎定量诊断的临床价值[J].兰州大学学报(医学版),2016,42(5):26-30.