肾动脉多普勒超声检查在评价移植肾功能中的作用

摘要

Objective:To evaluate the clinical value of renal artery Doppler ultrasonography in the diagnosis of renal transplant dysfunction by detecting blood perfusion in transplanted kidney with ultrasound .Methods:A total of 107 renal transplantation patients ,aged (38 .8 ± 1 .6) years in average ,including 68 new cases and 39 follow‐ups ,were recruited .Peak systolic velocity (PSV) ,end‐diastolic velocity (EDV) and resistance index (RI) ,in main renal artery ,renal segmental arteries and interlobar arteries of transplanted kidneys ,were examined by color Doppler ultrasonography .Results:Hemorheologic alterations in renal segmental arteries and interlobar arteries were closely correlated with renal function .Correlation indexes between PSV and clearance of creatinine (Ccr) were r=0 .072(P>0 .05) ,r=0 .224 (P=0 .014) and r=0 .250 (P=0 .006) ,respectively ,in main renal artery ,renal segmental arteries and interlobar arteries .Correlation indexes between RI and Ccr were r= -0 .398 (P<0 .001) ,r= -0 .400(P<0 .001) and r= -0 .436(P<0 .001) ,respectively ,in main renal artery ,renal segmental arteries and interlobar arteries .Correlation indexes between EDV and Ccr were r=0 .446(P<0 .001) ,r=0 .659(P<0 .001) and r=0 .529(P< 0 .001) ,respectively ,in main renal artery ,renal segmental arteries and interlobar arteries .The above results indicated that ,the maintenance of diastolic blood flow in renal arteries was important for renal function .The increase of RI and decrease of EDV in arteries of transplanted kidney was characteristic manifestation of chronic allograft nephropathy and vasculitic rejection .Conclusions:Renal artery Doppler ultrasonography can effectively measure the hemorheologic alterations of transplanted kidney ,thus it is an important adjuvant diagnostic tool for clinical renal transplantation .%目的：通过超声检查移植肾肾动脉的血流供应情况，评价肾动脉多普勒超声检查用于诊断移植肾失功能的临床价值。方法：本研究共入组107例肾移植患者，平均年龄（38．8±1．6）岁；其中68例为新近肾移植手术患者，39例为长期随访患者。通过彩色多普勒超声测量移植肾主肾动脉、段间动脉、叶间动脉的收缩期峰值流速（PSV ）和舒张末期流速（EDV ）以及阻力指数（R I ）。结果：肾脏段间动脉和叶间动脉的血液流变学改变与肾脏功能的关系较为密切。主肾动脉、肾脏段间动脉和叶间动脉的PS V与内生肌酐清除率的相关指数 r分别为0．072（ P＞0．05）、0．224（ P＝0．014）、0．250（ P＝0．006）。主肾动脉、肾脏段间动脉和叶间动脉的RI与内生肌酐清除率的相关指数 r分别为－0．398（ P＜0．001）、－0．400（ P＜0．001）、－0．436（P＜0．001）。主肾动脉、肾脏段间动脉和叶间动脉的 EDV 与内生肌酐清除率的相关指数 r分别为－0．446（P＜0．001）、0．659（ P＜0．001）、0．529（ P＜0．001）。以上结果提示，舒张期肾动脉血流的维持对肾脏功能有重要意义。进一步联合肾穿刺检查结果发现，移植肾内动脉RI升高和EDV降低是慢性移植物肾病和血管炎性排异反应的特征性表现。结论：肾动脉多普勒超声检查能有效地检测移植肾脏的血流改变，是临床肾移植中的重要辅助诊断工具。