超声造影评价不同程度肝硬化患者肾脏血流灌注的临床研究
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摘要
目的：应用实时超声造影技术结合时间—强度曲线定量评价不同程度肝硬化患者肾脏血流灌注情况,寻找超声造影定量参数变化和肝硬化病程的关系,为发现肝硬化肾脏血流灌注异常提供临床依据。
方法：肝硬化患者31例,其中代偿期肝硬化组13例,失代偿期肝硬化组18例,并据肝功能Child-Pugh评分法对所有肝硬化患者进行评分；正常对照组30例。二维超声取得右侧肾脏最大长轴断面图像后,在实时超声造影条件下(机械指数0.07)观察肾脏血流灌注,并储存造影动态图像,然后应用QontraXt软件对肾脏皮质血流灌注进行定量分析,量化参数包括峰值强度、达峰值时间、曲线尖度、曲线下面积和峰值强度比率。以正常组为对照,比较代偿期和失代偿期肝硬化患者肾脏的血流灌注及时间-强度曲线量化参数的变化情况,并将肝硬化患者肾脏的血流灌注参数与Child-Pugh评分进行关联性分析。
结果：①与正常组相比,代偿期肝硬化组峰值强度、峰值强度比率测值减低,差异有统计学意义(P<0.05),达峰时间测值升高,但差异无统计学意义(P>0.05)；失代偿期肝硬化组峰值强度、峰值强度比率测值进一步减低,差异有统计学意义(P<0.01),达峰时间测值明显升高,差异有统计学意义(P<0.01)。与代偿期肝硬化组相比,失代偿期肝硬化组峰值强度测值减低,差异有统计学意义(P<0.01),峰值强度比率测值减低,差异有统计学意义(P<0.05)。各组之间曲线下面积、曲线尖度比较差异均无统计学意义(P>0.05)。
②肝硬化组超声造影定量参数峰值强度及峰值强度比率与Child-Pugh评分值呈负相关(P<0.01,P<0.05)；而达峰时间、曲线尖度、曲线下面积均与Child-Pugh评分值不存在相关关系(P>0.05)。
结论：超声造影结合时间—强度曲线可定量分析不同程度肝硬化患者肾脏血流灌注情况。肝硬化时肾脏皮质超声造影参数峰值强度和峰值强度比率的变化与肝硬化的病变程度密切相关,是反映肝硬化患者肾脏血流灌注的较好参数指标。
Objective:To access the renal perfusion in patients with liver cirrhosis at different levels by contrast-enhanced ultrasound with time-intensity curve and investigate relationships between the parameters of the time intensity curve and degrees of patients with liver cirrhosis, for the detection of abnormalities of renal perfusion to provide basis for clinic.
Methods:Thirty-one patients with liver cirrhosis were divided into:thirteen compensated cirrhosis group and eighteen decompensated cirrhosis group; thirty normal controls. Child-pugh scores were calculated for all the patients of hepatocirrhosis. Maximal long-axis cross-section image of renal was acquired by 2D ultrasound and then contrast-enhanced ultrasound (MI=0.07) was performed on right kidney. Renal perfusion was analyzed quantitatively with the time-intensity curve by QontraXt software. The parameters of the time intensity curve include peak signal intensity (Peak), time to peak intensity (TP), sharpness and area under the curve (AUC), ratio of peak intensity (RP). Investigate the changes of renal perfusion and time-intensity curve parameters in hepatocirrhosis at different levels. The relationships between parameters and child-pugh scores of patients with liver cirrhosis were studied.
Results:①Compared with the normal group, peak signal intensity and ratio of peak intensity decreased in the compensated cirrhosis group (P<0.05), time to peak delayed in compensated cirrhosis group, but it showed no statistical significance (P>0.05), peak signal intensity and ratio of peak intensity decreased in decompensated cirrhosis group (P<0.01), time to peak delayed significantly and were statistically significant (P<0.01). Compared with the compensated cirrhosis group, peak intensity decreased in the decompensated cirrhosis group (P<0.01), ratio of peak intensity decreased in the decompensated cirrhosis group (P<0.05).Sharpness and area under the curve showed no statistical significance in the three groups (P>0.05).
②Peak signal intensity and ratio of peak intensity showed a significant correlation with the Child-Pugh score (P<0.01, P<0.05). Time to peak, sharpness and area under the curve showed no correlation with the Child-Pugh score (P>0.05).
Conclusions:Contrast-enhanced ultrasound combined with time-intensity curve can analyze renal perfusion of hepatocirrhosis quantitatively at different stages. Peak signal intensity and ratio of peak intensity closely related to the degree of cirrhosis, which are good parameters for renal perfusion in hepatocirrhosis.
方法：肝硬化患者31例,其中代偿期肝硬化组13例,失代偿期肝硬化组18例,并据肝功能Child-Pugh评分法对所有肝硬化患者进行评分；正常对照组30例。二维超声取得右侧肾脏最大长轴断面图像后,在实时超声造影条件下(机械指数0.07)观察肾脏血流灌注,并储存造影动态图像,然后应用QontraXt软件对肾脏皮质血流灌注进行定量分析,量化参数包括峰值强度、达峰值时间、曲线尖度、曲线下面积和峰值强度比率。以正常组为对照,比较代偿期和失代偿期肝硬化患者肾脏的血流灌注及时间-强度曲线量化参数的变化情况,并将肝硬化患者肾脏的血流灌注参数与Child-Pugh评分进行关联性分析。
结果：①与正常组相比,代偿期肝硬化组峰值强度、峰值强度比率测值减低,差异有统计学意义(P<0.05),达峰时间测值升高,但差异无统计学意义(P>0.05)；失代偿期肝硬化组峰值强度、峰值强度比率测值进一步减低,差异有统计学意义(P<0.01),达峰时间测值明显升高,差异有统计学意义(P<0.01)。与代偿期肝硬化组相比,失代偿期肝硬化组峰值强度测值减低,差异有统计学意义(P<0.01),峰值强度比率测值减低,差异有统计学意义(P<0.05)。各组之间曲线下面积、曲线尖度比较差异均无统计学意义(P>0.05)。
②肝硬化组超声造影定量参数峰值强度及峰值强度比率与Child-Pugh评分值呈负相关(P<0.01,P<0.05)；而达峰时间、曲线尖度、曲线下面积均与Child-Pugh评分值不存在相关关系(P>0.05)。
结论：超声造影结合时间—强度曲线可定量分析不同程度肝硬化患者肾脏血流灌注情况。肝硬化时肾脏皮质超声造影参数峰值强度和峰值强度比率的变化与肝硬化的病变程度密切相关,是反映肝硬化患者肾脏血流灌注的较好参数指标。
Objective:To access the renal perfusion in patients with liver cirrhosis at different levels by contrast-enhanced ultrasound with time-intensity curve and investigate relationships between the parameters of the time intensity curve and degrees of patients with liver cirrhosis, for the detection of abnormalities of renal perfusion to provide basis for clinic.
Methods:Thirty-one patients with liver cirrhosis were divided into:thirteen compensated cirrhosis group and eighteen decompensated cirrhosis group; thirty normal controls. Child-pugh scores were calculated for all the patients of hepatocirrhosis. Maximal long-axis cross-section image of renal was acquired by 2D ultrasound and then contrast-enhanced ultrasound (MI=0.07) was performed on right kidney. Renal perfusion was analyzed quantitatively with the time-intensity curve by QontraXt software. The parameters of the time intensity curve include peak signal intensity (Peak), time to peak intensity (TP), sharpness and area under the curve (AUC), ratio of peak intensity (RP). Investigate the changes of renal perfusion and time-intensity curve parameters in hepatocirrhosis at different levels. The relationships between parameters and child-pugh scores of patients with liver cirrhosis were studied.
Results:①Compared with the normal group, peak signal intensity and ratio of peak intensity decreased in the compensated cirrhosis group (P<0.05), time to peak delayed in compensated cirrhosis group, but it showed no statistical significance (P>0.05), peak signal intensity and ratio of peak intensity decreased in decompensated cirrhosis group (P<0.01), time to peak delayed significantly and were statistically significant (P<0.01). Compared with the compensated cirrhosis group, peak intensity decreased in the decompensated cirrhosis group (P<0.01), ratio of peak intensity decreased in the decompensated cirrhosis group (P<0.05).Sharpness and area under the curve showed no statistical significance in the three groups (P>0.05).
②Peak signal intensity and ratio of peak intensity showed a significant correlation with the Child-Pugh score (P<0.01, P<0.05). Time to peak, sharpness and area under the curve showed no correlation with the Child-Pugh score (P>0.05).
Conclusions:Contrast-enhanced ultrasound combined with time-intensity curve can analyze renal perfusion of hepatocirrhosis quantitatively at different stages. Peak signal intensity and ratio of peak intensity closely related to the degree of cirrhosis, which are good parameters for renal perfusion in hepatocirrhosis.
引文
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[21]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.
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[2]秦威,文艳玲.超声造影在肾脏疾病临床诊断中的应用.中华医学超声杂志(电子版),2007,4(2) 121-122.
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[18]董怡,陈为民,王文平,等.超声造影定量分析超声评价犬慢性缺血性肾病：与彩色多普相比.中国医学影像技术,2009,25(9)：1449-1452.
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[2]Francoz C, Glotz D, Moreaul R, et al. The evaluation of renal function and disease in patients with cirrhosis. J Hepatology,2010,52(4):605-613.
[3]严颖.肝肾综合征.国外医学内科学分册,2002,29(5)：581-781.
[4]贾继东.HRS的发病机制.中华肝脏病杂志,2003,11(10)：626.
[5]蒋洁,王金锐,江凌,等.超声造影评价肾皮质血流灌注.中华医学超声杂志,2007,15(7)：530.
[6]薛雁山,尚存海,胡玉川,等.多层螺旋CT对肝硬化患者肾脏血流灌注扫描的研究.中国医学影像技术,2007,23(10)：1539-1543.
[7]董怡,王文平,丁红,等.超声造影定量分析技术诊断早期肾功能损害的临床价值.上海医学,2009,32(3)：212-213.
[8]叶任高,钟南山,田德安,等.内科学.第七版,北京：人民卫生出版社,2008：452-453.
[9]Santiago J, Munoz, MD. The Hepatorenal Syndrome. Med Clin North Am,2008,92(4):813-837.
[10]Andres C. The Hepatorenal Syndrome. Clin Liver Dis,2006,10(4):371-385.
[11]杨惠玲,潘景轩,吴伟康.高级病理生理学.第二版,北京：科学出版社,2006,205-206.
[12]Correas JM, Claudon M, Tranquart F, et al. The kidney:imaging with microbubble contrast agents. Ultrasound Q.2006,22(1):53-66.
[13]赵玉珍.超声造影及其临床应用.中国医疗设备,2008,23(9)：147-148.
[14]秦威,文艳玲.超声造影在肾脏疾病临床诊断中的应用.中华医学超声杂志(电子版),2007,4(2)：121-122.
[15]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.
[16]邓旦,廖明松,李树森,等.能量多普勒应用于肝硬化进程中肾脏血流动力学观测的价值.中国超声医学杂志,2003,19(3)：190-192.
[17]王燕,柳立平,白文元,等.彩色多普勒超声对肝硬化门静脉高压症患者肾血流动力学改变的研究.中华超声影像学杂志,2004,13(7)：554-555.
[18]戴晴,姜玉新.超声造影的临床应用.中国医学科学院学报,2008,30(1)：1.
[19]Rivolta R, Maggi A, Cazzanign M, et al. Reduction of renal cortical blood flow assessed by Doppler in cirrhotic patients with refractory ascites. J, Hepatogology,1998,28 (5):1235-1238.
[20]Lim YS, Larson TS, Benson JT, et al. Serum sodium, renal function and survival of patients with end-stage liver disease. J Hepatogology,2010,28 (1):1-2.
[21]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.
[22]邹万中.肾活检病理学.第一版,北京：北京大学医学出版社,2006,110.
[23]梁彤,梁峭嵘,黄春燕,等.肾脏外伤的灰阶超声,彩色多普勒超声和超声造影的对比研究.中华医学超声杂志(电子版),2007,4(1)：32-33.
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