三维血管容积显像诊断移植肾急性排异的应用价值

摘要

目的 探讨三维血管容积显像在诊断肾移植术后急性排异(AR)中的应用价值.方法 对30例肾功能稳定期受检者及13例移植肾AR患者进行彩色多普勒血流显像(CDFI)和三维血管容积参数采集与分析,应用受试者工作特征(ROC)曲线比较各项参数的诊断价值.结果 AR组与移植肾功能稳定组比较,阻力指数(RI)及搏动指数(PI)明显升高,差异有统计学意义(分别为P<0.005、P0.05);VFI与RI、体积(V)、PI曲线下面积比较差异有统计学意义(P<0.05).以VFI≤18.78%作为临界值,诊断AR的敏感性为70.O%,特异性为93.3%,阳性预测值为60.8%,阴性预测值为93.4%.结论 三维血管容积显像参数VFI诊断AR的特异性和敏感性高于血流参数RI和PI;VFI的最佳临界点为≤18.78%.可能为早期诊断AR提供新的有用指标.%Objective To evaluate the value of three-dimensional (3D) ultrasonic imaging of vascular volume in assessing postoperative acute rejection(AR) of renal transplant patients. Methods Color Doppler flow imaging(CDFI) and 3D vascular volumetric parameters were collected and analyzed in 30 cases with stable renal function (control group) and 13 cases with AR of kidney transplantation (AR group). The diagnostic performances of each ultrasonic parameter were compared by receiver operating characteristic (ROC) curve. Results The parameters of resistance index(RI) and pulsatility index(PI) in AR group were significantly higher than those in control group( P <0.005 and P <0. 05, respectively). Analysis of the areas under ROC curve showed that the area under VFI curve was the largest;no significant difference( P > 0. 05) was found compared the area under VFI curve to those areas under VI,FI and MG curves;Comparing the area under VFI curve to those under RI, V and PI,there were significant differences( P <0. 05). Taking VFI≤18. 78% as the critical value, the sensitivity and specificity for the diagnosis of AR of transplanted kidneys were 70. 0% and 93. 3% ,and the positive and negative predictive values were 60. 8% and 93. 4%, respectively. Conclusions The sensitivity and specifity of 3D vascular volumetric imaging parameter VFI in the diagnosis of transplanted kidneys with AR were higher than those of blood flow parameters RI and PL VFI with the optimal critical value of ≤18. 78% might be a useful index for the early diagnosis of transplanted kidneys with AR.