超声造影对糖尿病兔肾脏血流灌注的实验研究
|
摘要
目的:以血肌酐、尿素氮、病理检查作为参照,应用实时超声造影技术结合时间-强度曲线定量评价糖尿病兔早期不同阶段肾皮质血流灌注特点及变化规律。
方法:健康雄性成年家兔40只,随机分为正常对照组、糖尿病组,将四氧嘧啶按100mg/kg体重由耳缘静脉快速注射入糖尿病组体内,建立糖尿病兔模型;对照组注射生理盐水,之后自由进食水。分别于3天、1周、2周、4周、6周、8周、10周、12周抽取对照组和糖尿病组兔血化验血肌酐、尿素氮;然后在实时造影条件(机械指数0.088)下进行超声造影观察双侧肾脏血流灌注模式并储存造影动态图像,造影完毕,随机处死一只兔,摘取肾脏行病理检查,最后应用仪器内置的时间-强度量化分析软件对肾皮质血流灌注进行定量分析,量化参数包括达峰时间、曲线上升斜率、峰值强度、曲线下面积以及峰值强度减半时间等。以血生化指标及病理结果作为参照,与对照组比较,观察糖尿病兔早期不同阶段肾皮质的血流灌注变化情况。
结果:糖尿病组兔注射四氧嘧啶后肾皮质血流灌注增大,1周、2周表现为时间-强度曲线参数中峰值强度升高、曲线下面积增大、达峰时间缩短、曲线上升斜率升高,此时病理可见肾小球肥大,系膜基质正常,基底膜无增厚;4周、6周,峰值强度、曲线下面积高于对照组,达峰时间、曲线上升斜率接近正常,系膜细胞增多。8周、10周、12周,达峰时间延长、曲线上升斜率减慢、峰值强度减半时间延长,病理出现肾小球系膜细胞明显增多,系膜基质增生,基底膜增厚,至12周病理出现部分毛细血管管腔闭塞,肾小球节段性硬化,峰值强度测值减低。对照组与糖尿病组各时间点血肌酐、尿素氮测值比较差异均无统计学意义。
结论:
1.超声造影定量分析可早期发现糖尿病肾血流灌注异常。
2.糖尿病兔肾血流灌注的变化早于常规血生化改变。
3.在糖尿病肾病发生、发展过程中,超声造影各参数变化与病理变化密切相关。
Objective: To access the characteristic and changes of the renal perfusion of diabetic rabbits at different stages by real-time contrast-enhanced ultrasound with time-intensity curve.
Methods: 40 adult male rabbits were divided into control group and diabetes group at random. The models of diabetes were established by intravenously injecting alloxan, with sodium chloride for the control group. Scr and BUN were examined at 3d, 1w, 2w, 4w, 6w, 8w, 10w and 12w post-injection respectively for every group Real-time contrast-enhanced ultrasound were performed on bilateral kidney to observe the renal perfusion of both kidneys. After that, one rabbit was sacrificed randomly at each time point and its kidney was sampled for pathological examination. Renal perfusion was analyzed quantitatively with the time-intensity curve. The parameters of the time intensity curve included time to peak intensity (PIT), ascending slope rate of the curve, peak signal intensity (PSI), area under the curve (AUC) and time to half of peak intensity (HPT). Reference to the pathology and blood biochemistry, the study investigated the changes of blood perfusion and time-intensity curve parameters in diabetes rabbits at different stages.
Results: The renal perfusion was increased in diabetes group after the injection of alloxan. The PSI, AUC and ascending slope rate of the curve of the time-intensity curve were increased in 1w and 2w with decreased of HPT; the pathological examination exhibited glomeruli hypertrophy and no thickening of basal lamina. The PSI and AUC in 4w and 6w were more than that of control group; the PIT and ascending slope rate of the curve got closed to normal in 4w and 6w; the intercapillary cells increased. The speed of ascending slope rate of the curve in 8w, 10w and 12w was slower, shown as PIT and HPT delayed; the pathological examination showned increasing of mesangial cell, hyperplasia of mesangial matrix and thickening of basal lamina, followed with obliteration of partial micrangium, glomerular sclerosis and reduce of PSI in 12w. Analysed the Scr and BUN in two groups, there was no significant difference.
Conclusions:
1. Contrast-enhanced ultrasound combined with time-intensity curve can analyze renal perfusion of diabetes quantitatively.
2. The changes of renal perfusion in diabetic rabbits were earlier than that of blood biochemistry.
3. The parameters’changes of contrast-enhanced ultrasound were closely related with pathology in diabetic nephropathy.
方法:健康雄性成年家兔40只,随机分为正常对照组、糖尿病组,将四氧嘧啶按100mg/kg体重由耳缘静脉快速注射入糖尿病组体内,建立糖尿病兔模型;对照组注射生理盐水,之后自由进食水。分别于3天、1周、2周、4周、6周、8周、10周、12周抽取对照组和糖尿病组兔血化验血肌酐、尿素氮;然后在实时造影条件(机械指数0.088)下进行超声造影观察双侧肾脏血流灌注模式并储存造影动态图像,造影完毕,随机处死一只兔,摘取肾脏行病理检查,最后应用仪器内置的时间-强度量化分析软件对肾皮质血流灌注进行定量分析,量化参数包括达峰时间、曲线上升斜率、峰值强度、曲线下面积以及峰值强度减半时间等。以血生化指标及病理结果作为参照,与对照组比较,观察糖尿病兔早期不同阶段肾皮质的血流灌注变化情况。
结果:糖尿病组兔注射四氧嘧啶后肾皮质血流灌注增大,1周、2周表现为时间-强度曲线参数中峰值强度升高、曲线下面积增大、达峰时间缩短、曲线上升斜率升高,此时病理可见肾小球肥大,系膜基质正常,基底膜无增厚;4周、6周,峰值强度、曲线下面积高于对照组,达峰时间、曲线上升斜率接近正常,系膜细胞增多。8周、10周、12周,达峰时间延长、曲线上升斜率减慢、峰值强度减半时间延长,病理出现肾小球系膜细胞明显增多,系膜基质增生,基底膜增厚,至12周病理出现部分毛细血管管腔闭塞,肾小球节段性硬化,峰值强度测值减低。对照组与糖尿病组各时间点血肌酐、尿素氮测值比较差异均无统计学意义。
结论:
1.超声造影定量分析可早期发现糖尿病肾血流灌注异常。
2.糖尿病兔肾血流灌注的变化早于常规血生化改变。
3.在糖尿病肾病发生、发展过程中,超声造影各参数变化与病理变化密切相关。
Objective: To access the characteristic and changes of the renal perfusion of diabetic rabbits at different stages by real-time contrast-enhanced ultrasound with time-intensity curve.
Methods: 40 adult male rabbits were divided into control group and diabetes group at random. The models of diabetes were established by intravenously injecting alloxan, with sodium chloride for the control group. Scr and BUN were examined at 3d, 1w, 2w, 4w, 6w, 8w, 10w and 12w post-injection respectively for every group Real-time contrast-enhanced ultrasound were performed on bilateral kidney to observe the renal perfusion of both kidneys. After that, one rabbit was sacrificed randomly at each time point and its kidney was sampled for pathological examination. Renal perfusion was analyzed quantitatively with the time-intensity curve. The parameters of the time intensity curve included time to peak intensity (PIT), ascending slope rate of the curve, peak signal intensity (PSI), area under the curve (AUC) and time to half of peak intensity (HPT). Reference to the pathology and blood biochemistry, the study investigated the changes of blood perfusion and time-intensity curve parameters in diabetes rabbits at different stages.
Results: The renal perfusion was increased in diabetes group after the injection of alloxan. The PSI, AUC and ascending slope rate of the curve of the time-intensity curve were increased in 1w and 2w with decreased of HPT; the pathological examination exhibited glomeruli hypertrophy and no thickening of basal lamina. The PSI and AUC in 4w and 6w were more than that of control group; the PIT and ascending slope rate of the curve got closed to normal in 4w and 6w; the intercapillary cells increased. The speed of ascending slope rate of the curve in 8w, 10w and 12w was slower, shown as PIT and HPT delayed; the pathological examination showned increasing of mesangial cell, hyperplasia of mesangial matrix and thickening of basal lamina, followed with obliteration of partial micrangium, glomerular sclerosis and reduce of PSI in 12w. Analysed the Scr and BUN in two groups, there was no significant difference.
Conclusions:
1. Contrast-enhanced ultrasound combined with time-intensity curve can analyze renal perfusion of diabetes quantitatively.
2. The changes of renal perfusion in diabetic rabbits were earlier than that of blood biochemistry.
3. The parameters’changes of contrast-enhanced ultrasound were closely related with pathology in diabetic nephropathy.
引文
1刘志红.糖尿病肾病.中华肾脏病杂志, 2000, 16(2): 126-131.
2 Raine AE. Epidemiology, development and treatment of end-stage renal failure in type 2(non-insulin-dependent)diabetic patients in Europe. Diabetologia, 1993, 36(10): 1099-1104.
3 Raine AE. The rising tide of diabetic nephropathy. The warning before the flood? (Editorial Comments). Nephrol Dial Transplant, 1995, 10(4):460-461.
4杨念生,肖海鹏.糖尿病肾病诊治新进展.新医学, 2004, 35(2): 111-119.
5 Mogenson CE. Prediction of clinical diabetic nephropathy in IDDM patients. Alternatives to microalbuminuria? Diabetes, 1990, 39(7): 761-767.
6 Simons JL, Provoost AP, Anderson S, et al. Modulation of glomerular hypertension defines susceptibility to progressive glomerular injury. KidneyInt, 1994, 46(2): 396-404.
7 Mogensen CE, Christensen CK. Predicting diabetic nephropathy in insulin-dependent patients. N Engl J Med, 1984, 311(2): 89-93.
8 Mogensen CE, Chachati A, Christensen, et al. Microabuminuria: An early marker of renal involvement in diabetics. Uremia Invest, 1986, 9(2): 85
9祁忠华,林善锬.高血糖导致肾脏高灌注的机制研究.中华医学杂志, 1994, 74(1): 5-8.
10王海燕.肾脏病学.第二版,北京:人民卫生出版社, 2001: 957.
11 Georage AT, Carol EB, Brent H, et al. Renal cortical ischemia in rabbits revealed by contrast enhanced power Doppler sonography. AJR, 1998, 170(2): 417-422.
12陆林忠.实时超声造影中MI和DP的意义和作用.声学技术, 2004, 23(3): 84-86.
13 Wei K, Le E, Bin JP, et al. Quantification of renal blood flow with contrast-enhanced ultrasound. Am Coll Cardiol, 2001, 37(4): 1135-1140.
14王健,康春松,徐琨,等.实时灰阶超声造影研究兔肾血流灌注.中华超声影像学杂志, 2008, 17(1): 170-172.
15王健,康春松,李嵘娟,等.实时灰阶超声造影评价肾动脉狭窄血流灌注的实验研究.中国医学影像技术,2007,23(10): 1449-1452.
16王健,康春松,李虹,等.实时灰阶超声造影研究兔急性肾功能衰竭的血流灌注.中华超声影像学杂志, 2008, 17(2): 69-72.
17康春松,刘睿宏,杨永生,等.肝转移癌超声造影临床应用研究.中国医学影像技术2007, 23(3): 424-427.
18康春松,杨学英,杨永生,等.肝血管瘤超声造影模式探讨.中华超声影像学杂志, 2006, 15(7): 553-554.
19杜联芳,李凡,姜露莹,等.超声造影在肾占位性病变中的应用.中华超声影像学杂志, 2006, 15(11): 813-815.
20 Nilsson A. Contrast-enhanced ultrasound of the kidneys. Eur Radiol Suppl, 2004, 14(8): 104-109.
21朱昆,毕黎琦.糖尿病兔肾小管间质损伤标志物变化及长春新碱的干预作用.中国老年学杂志, 2006, 26(2): 220-221.
22朱昆,潘洪涛,罗萍,等.四氧嘧啶诱发兔糖尿病模型的胰岛素管理及糖尿病肾病模型建立.吉林医学, 2006, 27(9): 1010-1011.
23 Chang S, Hypolite JA, DiSanto ME, et al.Increased basal phosphorylation of detrusor smooth muscle myosin in alloxan-induced diabetic rabbit is mediated by upregulation of Rho-kinase and CPI-17. Am J Physiol Renal Physiol, 2006, 290(3): 650-656.
24李杰,梁萍.彩色多普勒超声和超声造影在肝脏占位性病变中的应用进展.消化外科, 2002, l(5): 377-380.
25陆再英,钟南山.内科学.第7版.北京:人民卫生出版社, 2008: 776.
26 Girard MS, Mattrey RF, Baker KG, et al. Comparison of standard and second harmonic B-mode sonography in the detection of segmental renal infarction with sonographic contrast in a rabbit model. Ultrasound Med, 2000, 19(3): 185-192.
27姜玉新.超声造影的基础研究与临床应用.中国医学影像技术, 2004, 20(3): 523.
28 Mor-Avi V, Caiani EG, Collins KA, et al. Combined assessment of myocardial perfusion and regional left vent ricular function by analysis of contrast-enhanced power modulation images. Circulation, 2001, 104 (3): 352-357.
29杨未晓,高云华,朱贤胜.自制氟碳声学造影剂定量评价正常肾血流灌注的实验研究.中国超声医学杂志, 2002, 18(2): 97-100.
30 Schlosser T, Pohl C, Veltmann C, et al. Feasibility of the flash-replenishment concept in renal tissue: which parameters affect the assessment of t he cont rast replenishment ? Ultrasound Med Biol, 2001, 27(7): 937-944.
31牛海燕,简文豪,刘梅,等.声学造影评价肾实质血流灌注的实验研究.中国超声医学杂志, 2006, 22(7): 496-498.
32刘利平,于晓玲,李华,等.正常人肝脏灰阶超声造影定量研究.中国超声医学杂志, 2006, 22(4): 305-308.
33高鑫,左静南,侯积寿,等.实验性糖尿病大鼠早期肾脏结构和功能的改变.中华肾脏病杂志, 1989, 5(2): 71-75.
34李保春,王林辉,梅小斌.糖尿病性肾病.上海:第二军医大学出版社, 2005: 23-25.
35苗立英,秦达,王金锐,等.超声造影对弥漫性肾病肾血流灌注的评价.中华医学超声杂志(电子版), 2007, 4(2): 98-101.
36 Wei K, Le E, Bin JP, et al. Quantification of renal blood flow with contrast-enhanced ultrasound. J Am Coll Cardiol, 2001, 37(4): 1135–1140.
37 Nicolau C, Catala V, Vilana R, et al. Evaluation of hepatocellular carcinoma using SonoVue,a second generation ultrasound contrast agent:correlation with cellular differentiation. Eur Radiol, 2004, 14(6): 1092-1099.
38 Seidel G, Algemissen C, Christoph A, et al.Harmonic imaging of the human brain. Visualization of brain perfusion with ultrasound. Stroke, 2000, 31(1): 151-154.
39 MARTIN BAK, KLAUS THOMSEN, THORA CHRISTIANSEN, et al.Renal Enlargement Precedes Renal Hyperfiltration in Early Experimental Diabetes in Rats. J Am Soc Nephrol, 2000, 11(7): 1287–1292.
40吴永贵,林善锬,周江华,等.苯那普利对糖尿病大鼠肾小管-间质损伤的保护作用及机制.中华内分泌代谢杂志, 2003, 19(5): 406–407.
41 Forbes JM, Cooper ME, Thallas V, et al. Reduction of the accumulation of advanced glycation end products by ACE inhibition in experimental diabetic nephropathy. Diabetes, 2002, 51(11): 3274-3282.
42 Mumtaz FH, Dashwood MR, Khan MA, et al. Down-regulation of nitric oxide synthase in the diabetic rabbit kidney: potential relevance to the early pathogenesis of diabetic nephropathy. Curr Med Res Opin, 2004, 20(1): 1-6.
43郭啸华,刘志红,李恒,等.高糖高脂饮食诱导的2型糖尿病大鼠模型及其肾病特点.中国糖尿病杂志, 2002, 10(5): 290-294.
44王宗保,袁中华,余坚,等.诱发糖尿病饲料致新西兰兔动脉粥样硬化时血糖、血胰岛素和肝、肾、胰组织结构的变化.中国动脉硬化志, 2001, 9(5): 391-393.
45 Wei P, Lane PH, Lane JT, et al. Glomerular structural and functional changes in a high-fat diet mouse model of early-stage type 2 diabetes. Diabetologia, 2004, 47(9): 1541-1549.
1 Quaia E, Calliada F, Bertolotto M, et al. Characterization of focal liver lesions with contrast-specific US modes and a sulfur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence. Radiology, 2004, 232: 420-430.
2 Mogenson CE. Early Diabetic Renal Involvement and Nephropaphy. The Diabtes Annual, 1987, 306.
3 Mogenson CE. Predicting diabetic nephropathy in insulin-dependent patien. Diabetes, 1990, (39): 761.
4祁忠华,林善锬.高血糖导致肾脏高灌注的机制研究.中华医学杂志, 1994, 74(1) : 5-8.
5 Schwieger J, Fine LG. Renal hypertrophy,growth factors and Nephropathy in diabetes mellitus. Semin Nephrol, 1990, (10): 160.
6 Seyer Hamsenk. Renal hypertrophy in experimental diabetes mellitus. Kidney Int, 1983, (23): 643.
7 Nowack R, Raume, Blum W, et al. Haemodynamics in newly diagnosed type 2( no-insulin-dependent ) diabetes pattients. Am J Kidney Dis, 1992, (20): 342 .
8耿纪录,董宝玮. B型超声显像仪测量糖尿病和糖耐量减低患者的肾脏体积.天津医药, 1997, (25): 281-283.
9刘玉春,顾敏琪,王海燕,等. B型超声显像仪测量肾脏体积的探讨.北京医科大学学报, 1990, (22): 168.
10郭桦,左红卫.三级肾动脉血流参数的二维多普勒超声检测.中国超声医学杂志, 1999, 15: 376-377.
11 Sperandeo M. Pulsed 2 wave color Doppler echography of the Intrarenal vessels in patients with insulin dependent diabetes mellitis and incipient nephrophathy. Arch Itla Urol Androl, 1996, 68(5):183-187.
12 Sauvain JL. Echo Doppler pulse desarteres intrarenales aspects normaux etpathologiques. Annals de Adiologie, 1991, (4): 237.
13细岛弘行. Intrarenal resistive Index(RI) from renal duplux Doppler sonography in diabetic patients with nephropathy.日本临床, 1998, (56 supply ): 505-509.
14 Maria-Adelaide Marzano, et al. Early Renal Involvement in Diabetes Mellitus:Comparison of Renal Doppler US and Radioisotope Evaluation of Glomerolar Hyperfiltration. Radiology, 1998, 209: 813-817.
15 Platt JF. Duplex Doppler evaluation of native kidney dysfunction: bstructive and nonobstructive disease. AJR, 1992, 158: 1035-1042.
16 Eui Ishimara. Intrarenal hemodynamic abnormalities in diabetic nephropathy measured by duplex Doppler sonography. Kidneey Int, 1997, 51: 1920-1957.
17 Boris Brkljaciě. Renal Vascular Resistance in Diabetic Nephropathy: Duplex Doppler US Evaluation. Radioligy, 1994, 192: 549-554.
18王海燕,王岩.彩色多普勒能量图对糖尿病患者肾血流动力学的研究.中国超声医学杂志, 1999, 15(7): 526-529.
19 Averkiou M, Powers J, Skyba D, et al. Ultrasound Contrast Imaging Research. Ultrasound Q, 2003, 19(1): 27-37.
20 Forsberg F, Liu JB, Chiou HJ, et al. Comparison of fundamental and wideband harmonic contrast imaging of liver tumors. Ultrasonics, 2000, 38(3): 110-113.
21 Girard MS, Mattrey RF, Baker KG, et al. Comparison of standard and second harmonic B-mode sonography in the detection of segmental renal infarction with sonographic contrast in a rabbit model. Ultrasound Med, 2000, 19(3): 185-192.
22 Farhat W, Traubici J, Sherman C, et al. Reliability of contrast enhanced sonography with harmonic imaging for detecting early renal scarring in experimental pyelonephritis in a porcine model: preliminary results. Urol, 2002, 168(3): 1114-1117.
23左松,刘政,高云华,等.二次谐波显像评价正常兔肾脏声学造影的实验研究.中国超声医学杂志, 2002, 18(4): 249-251.
24 Hancock J, Dittrich H, Jewitt DE, et al. Evaluation of myocardial, hepatic, and renal perfusion in a variety of clinical conditions using an intravenous ultrasound contrast agent (Optison) and second harmonic imaging. Heart, 1999, 81(6): 636-641.
25 Wei K, Le E, Bin JP, et al. Quantification of renal blood flow with contrast-enhanced ultrasound. Am Coll Cardiol, 2001, 37(4): 1135-1140.
26 Kishimoto N, Mori Y, Nishiue T, et al. Renal blood flow measurement with contrast-enhanced harmonic ultrasonography: evaluation of dopamine induced changes in renal cortical perfusion in humans. Clin Nephrol, 2003, 59(6): 423-428.
27 Huber S, Steinbach R, Sommer O, et al. Contrast-enhanced power Doppler harmonic imaging influence on visualization of renal vasculature. Ultrasound Med Biol, 2000, 26(7): 1109-1115.
28 Hosotani Y, Takahashi N, Kiyomoto H, et al. A new method for evaluation of split renal cortical blood flow with contrast echography. Hypertens Res, 2002, 25(1): 77-83.
29 Verbeek XA, Ledoux LA, Willigers JM, et al. Experimental investigation of the pulse inversion technique for imaging ultrasound contrast agents. Acoust Soc Am, 2000, 107(4): 2281-2290.
30 Thorsten S, Christian H. Diagnostic Accuracy of Phase-Inversion Tissue Harmonic Imaging Versus Fundamental B-Mode Sonography in the Evaluation of Focal Lesions of the Kidney. AJR, 2003, 180: 1639-1647.
31 Lefevre F, Correas JM, Briancon S, et al. Contrast-enhanced sonography of the renal transplant using triggered pulse-inversion imaging: preliminary results. Ult rasound Med Biol, 2002, 28(3): 303-314.
32 Wiesmann M, Bergmann-K, oster CU, et al. Renal perfusion imaging using contrast-enhanced phase-inversion ultrasound. Clin Nephrol, 2004, 62(6): 423-431.
33 Georage AT, Carol EB, Brent H, et al. Renal cortical ischemia in rabbits revealed by contrast enhanced power Doppler sonography. AJR, 1998, 170(2): 417-422.
2 Raine AE. Epidemiology, development and treatment of end-stage renal failure in type 2(non-insulin-dependent)diabetic patients in Europe. Diabetologia, 1993, 36(10): 1099-1104.
3 Raine AE. The rising tide of diabetic nephropathy. The warning before the flood? (Editorial Comments). Nephrol Dial Transplant, 1995, 10(4):460-461.
4杨念生,肖海鹏.糖尿病肾病诊治新进展.新医学, 2004, 35(2): 111-119.
5 Mogenson CE. Prediction of clinical diabetic nephropathy in IDDM patients. Alternatives to microalbuminuria? Diabetes, 1990, 39(7): 761-767.
6 Simons JL, Provoost AP, Anderson S, et al. Modulation of glomerular hypertension defines susceptibility to progressive glomerular injury. KidneyInt, 1994, 46(2): 396-404.
7 Mogensen CE, Christensen CK. Predicting diabetic nephropathy in insulin-dependent patients. N Engl J Med, 1984, 311(2): 89-93.
8 Mogensen CE, Chachati A, Christensen, et al. Microabuminuria: An early marker of renal involvement in diabetics. Uremia Invest, 1986, 9(2): 85
9祁忠华,林善锬.高血糖导致肾脏高灌注的机制研究.中华医学杂志, 1994, 74(1): 5-8.
10王海燕.肾脏病学.第二版,北京:人民卫生出版社, 2001: 957.
11 Georage AT, Carol EB, Brent H, et al. Renal cortical ischemia in rabbits revealed by contrast enhanced power Doppler sonography. AJR, 1998, 170(2): 417-422.
12陆林忠.实时超声造影中MI和DP的意义和作用.声学技术, 2004, 23(3): 84-86.
13 Wei K, Le E, Bin JP, et al. Quantification of renal blood flow with contrast-enhanced ultrasound. Am Coll Cardiol, 2001, 37(4): 1135-1140.
14王健,康春松,徐琨,等.实时灰阶超声造影研究兔肾血流灌注.中华超声影像学杂志, 2008, 17(1): 170-172.
15王健,康春松,李嵘娟,等.实时灰阶超声造影评价肾动脉狭窄血流灌注的实验研究.中国医学影像技术,2007,23(10): 1449-1452.
16王健,康春松,李虹,等.实时灰阶超声造影研究兔急性肾功能衰竭的血流灌注.中华超声影像学杂志, 2008, 17(2): 69-72.
17康春松,刘睿宏,杨永生,等.肝转移癌超声造影临床应用研究.中国医学影像技术2007, 23(3): 424-427.
18康春松,杨学英,杨永生,等.肝血管瘤超声造影模式探讨.中华超声影像学杂志, 2006, 15(7): 553-554.
19杜联芳,李凡,姜露莹,等.超声造影在肾占位性病变中的应用.中华超声影像学杂志, 2006, 15(11): 813-815.
20 Nilsson A. Contrast-enhanced ultrasound of the kidneys. Eur Radiol Suppl, 2004, 14(8): 104-109.
21朱昆,毕黎琦.糖尿病兔肾小管间质损伤标志物变化及长春新碱的干预作用.中国老年学杂志, 2006, 26(2): 220-221.
22朱昆,潘洪涛,罗萍,等.四氧嘧啶诱发兔糖尿病模型的胰岛素管理及糖尿病肾病模型建立.吉林医学, 2006, 27(9): 1010-1011.
23 Chang S, Hypolite JA, DiSanto ME, et al.Increased basal phosphorylation of detrusor smooth muscle myosin in alloxan-induced diabetic rabbit is mediated by upregulation of Rho-kinase and CPI-17. Am J Physiol Renal Physiol, 2006, 290(3): 650-656.
24李杰,梁萍.彩色多普勒超声和超声造影在肝脏占位性病变中的应用进展.消化外科, 2002, l(5): 377-380.
25陆再英,钟南山.内科学.第7版.北京:人民卫生出版社, 2008: 776.
26 Girard MS, Mattrey RF, Baker KG, et al. Comparison of standard and second harmonic B-mode sonography in the detection of segmental renal infarction with sonographic contrast in a rabbit model. Ultrasound Med, 2000, 19(3): 185-192.
27姜玉新.超声造影的基础研究与临床应用.中国医学影像技术, 2004, 20(3): 523.
28 Mor-Avi V, Caiani EG, Collins KA, et al. Combined assessment of myocardial perfusion and regional left vent ricular function by analysis of contrast-enhanced power modulation images. Circulation, 2001, 104 (3): 352-357.
29杨未晓,高云华,朱贤胜.自制氟碳声学造影剂定量评价正常肾血流灌注的实验研究.中国超声医学杂志, 2002, 18(2): 97-100.
30 Schlosser T, Pohl C, Veltmann C, et al. Feasibility of the flash-replenishment concept in renal tissue: which parameters affect the assessment of t he cont rast replenishment ? Ultrasound Med Biol, 2001, 27(7): 937-944.
31牛海燕,简文豪,刘梅,等.声学造影评价肾实质血流灌注的实验研究.中国超声医学杂志, 2006, 22(7): 496-498.
32刘利平,于晓玲,李华,等.正常人肝脏灰阶超声造影定量研究.中国超声医学杂志, 2006, 22(4): 305-308.
33高鑫,左静南,侯积寿,等.实验性糖尿病大鼠早期肾脏结构和功能的改变.中华肾脏病杂志, 1989, 5(2): 71-75.
34李保春,王林辉,梅小斌.糖尿病性肾病.上海:第二军医大学出版社, 2005: 23-25.
35苗立英,秦达,王金锐,等.超声造影对弥漫性肾病肾血流灌注的评价.中华医学超声杂志(电子版), 2007, 4(2): 98-101.
36 Wei K, Le E, Bin JP, et al. Quantification of renal blood flow with contrast-enhanced ultrasound. J Am Coll Cardiol, 2001, 37(4): 1135–1140.
37 Nicolau C, Catala V, Vilana R, et al. Evaluation of hepatocellular carcinoma using SonoVue,a second generation ultrasound contrast agent:correlation with cellular differentiation. Eur Radiol, 2004, 14(6): 1092-1099.
38 Seidel G, Algemissen C, Christoph A, et al.Harmonic imaging of the human brain. Visualization of brain perfusion with ultrasound. Stroke, 2000, 31(1): 151-154.
39 MARTIN BAK, KLAUS THOMSEN, THORA CHRISTIANSEN, et al.Renal Enlargement Precedes Renal Hyperfiltration in Early Experimental Diabetes in Rats. J Am Soc Nephrol, 2000, 11(7): 1287–1292.
40吴永贵,林善锬,周江华,等.苯那普利对糖尿病大鼠肾小管-间质损伤的保护作用及机制.中华内分泌代谢杂志, 2003, 19(5): 406–407.
41 Forbes JM, Cooper ME, Thallas V, et al. Reduction of the accumulation of advanced glycation end products by ACE inhibition in experimental diabetic nephropathy. Diabetes, 2002, 51(11): 3274-3282.
42 Mumtaz FH, Dashwood MR, Khan MA, et al. Down-regulation of nitric oxide synthase in the diabetic rabbit kidney: potential relevance to the early pathogenesis of diabetic nephropathy. Curr Med Res Opin, 2004, 20(1): 1-6.
43郭啸华,刘志红,李恒,等.高糖高脂饮食诱导的2型糖尿病大鼠模型及其肾病特点.中国糖尿病杂志, 2002, 10(5): 290-294.
44王宗保,袁中华,余坚,等.诱发糖尿病饲料致新西兰兔动脉粥样硬化时血糖、血胰岛素和肝、肾、胰组织结构的变化.中国动脉硬化志, 2001, 9(5): 391-393.
45 Wei P, Lane PH, Lane JT, et al. Glomerular structural and functional changes in a high-fat diet mouse model of early-stage type 2 diabetes. Diabetologia, 2004, 47(9): 1541-1549.
1 Quaia E, Calliada F, Bertolotto M, et al. Characterization of focal liver lesions with contrast-specific US modes and a sulfur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence. Radiology, 2004, 232: 420-430.
2 Mogenson CE. Early Diabetic Renal Involvement and Nephropaphy. The Diabtes Annual, 1987, 306.
3 Mogenson CE. Predicting diabetic nephropathy in insulin-dependent patien. Diabetes, 1990, (39): 761.
4祁忠华,林善锬.高血糖导致肾脏高灌注的机制研究.中华医学杂志, 1994, 74(1) : 5-8.
5 Schwieger J, Fine LG. Renal hypertrophy,growth factors and Nephropathy in diabetes mellitus. Semin Nephrol, 1990, (10): 160.
6 Seyer Hamsenk. Renal hypertrophy in experimental diabetes mellitus. Kidney Int, 1983, (23): 643.
7 Nowack R, Raume, Blum W, et al. Haemodynamics in newly diagnosed type 2( no-insulin-dependent ) diabetes pattients. Am J Kidney Dis, 1992, (20): 342 .
8耿纪录,董宝玮. B型超声显像仪测量糖尿病和糖耐量减低患者的肾脏体积.天津医药, 1997, (25): 281-283.
9刘玉春,顾敏琪,王海燕,等. B型超声显像仪测量肾脏体积的探讨.北京医科大学学报, 1990, (22): 168.
10郭桦,左红卫.三级肾动脉血流参数的二维多普勒超声检测.中国超声医学杂志, 1999, 15: 376-377.
11 Sperandeo M. Pulsed 2 wave color Doppler echography of the Intrarenal vessels in patients with insulin dependent diabetes mellitis and incipient nephrophathy. Arch Itla Urol Androl, 1996, 68(5):183-187.
12 Sauvain JL. Echo Doppler pulse desarteres intrarenales aspects normaux etpathologiques. Annals de Adiologie, 1991, (4): 237.
13细岛弘行. Intrarenal resistive Index(RI) from renal duplux Doppler sonography in diabetic patients with nephropathy.日本临床, 1998, (56 supply ): 505-509.
14 Maria-Adelaide Marzano, et al. Early Renal Involvement in Diabetes Mellitus:Comparison of Renal Doppler US and Radioisotope Evaluation of Glomerolar Hyperfiltration. Radiology, 1998, 209: 813-817.
15 Platt JF. Duplex Doppler evaluation of native kidney dysfunction: bstructive and nonobstructive disease. AJR, 1992, 158: 1035-1042.
16 Eui Ishimara. Intrarenal hemodynamic abnormalities in diabetic nephropathy measured by duplex Doppler sonography. Kidneey Int, 1997, 51: 1920-1957.
17 Boris Brkljaciě. Renal Vascular Resistance in Diabetic Nephropathy: Duplex Doppler US Evaluation. Radioligy, 1994, 192: 549-554.
18王海燕,王岩.彩色多普勒能量图对糖尿病患者肾血流动力学的研究.中国超声医学杂志, 1999, 15(7): 526-529.
19 Averkiou M, Powers J, Skyba D, et al. Ultrasound Contrast Imaging Research. Ultrasound Q, 2003, 19(1): 27-37.
20 Forsberg F, Liu JB, Chiou HJ, et al. Comparison of fundamental and wideband harmonic contrast imaging of liver tumors. Ultrasonics, 2000, 38(3): 110-113.
21 Girard MS, Mattrey RF, Baker KG, et al. Comparison of standard and second harmonic B-mode sonography in the detection of segmental renal infarction with sonographic contrast in a rabbit model. Ultrasound Med, 2000, 19(3): 185-192.
22 Farhat W, Traubici J, Sherman C, et al. Reliability of contrast enhanced sonography with harmonic imaging for detecting early renal scarring in experimental pyelonephritis in a porcine model: preliminary results. Urol, 2002, 168(3): 1114-1117.
23左松,刘政,高云华,等.二次谐波显像评价正常兔肾脏声学造影的实验研究.中国超声医学杂志, 2002, 18(4): 249-251.
24 Hancock J, Dittrich H, Jewitt DE, et al. Evaluation of myocardial, hepatic, and renal perfusion in a variety of clinical conditions using an intravenous ultrasound contrast agent (Optison) and second harmonic imaging. Heart, 1999, 81(6): 636-641.
25 Wei K, Le E, Bin JP, et al. Quantification of renal blood flow with contrast-enhanced ultrasound. Am Coll Cardiol, 2001, 37(4): 1135-1140.
26 Kishimoto N, Mori Y, Nishiue T, et al. Renal blood flow measurement with contrast-enhanced harmonic ultrasonography: evaluation of dopamine induced changes in renal cortical perfusion in humans. Clin Nephrol, 2003, 59(6): 423-428.
27 Huber S, Steinbach R, Sommer O, et al. Contrast-enhanced power Doppler harmonic imaging influence on visualization of renal vasculature. Ultrasound Med Biol, 2000, 26(7): 1109-1115.
28 Hosotani Y, Takahashi N, Kiyomoto H, et al. A new method for evaluation of split renal cortical blood flow with contrast echography. Hypertens Res, 2002, 25(1): 77-83.
29 Verbeek XA, Ledoux LA, Willigers JM, et al. Experimental investigation of the pulse inversion technique for imaging ultrasound contrast agents. Acoust Soc Am, 2000, 107(4): 2281-2290.
30 Thorsten S, Christian H. Diagnostic Accuracy of Phase-Inversion Tissue Harmonic Imaging Versus Fundamental B-Mode Sonography in the Evaluation of Focal Lesions of the Kidney. AJR, 2003, 180: 1639-1647.
31 Lefevre F, Correas JM, Briancon S, et al. Contrast-enhanced sonography of the renal transplant using triggered pulse-inversion imaging: preliminary results. Ult rasound Med Biol, 2002, 28(3): 303-314.
32 Wiesmann M, Bergmann-K, oster CU, et al. Renal perfusion imaging using contrast-enhanced phase-inversion ultrasound. Clin Nephrol, 2004, 62(6): 423-431.
33 Georage AT, Carol EB, Brent H, et al. Renal cortical ischemia in rabbits revealed by contrast enhanced power Doppler sonography. AJR, 1998, 170(2): 417-422.