彩色多普勒超声在儿童移植肾肾动脉狭窄中的应用研究

摘要

目的 探讨儿童移植肾肾动脉狭窄(T RAS )的彩色多普勒超声诊断价值.方法 回顾性分析82例临床疑诊T RAS的儿童肾移植患者的超声检查结果和临床资料,根据计算机断层扫描血管造影(CT A )检查结果分为狭窄组(21例)和非狭窄组(61例) ,分析两组患者移植肾超声血流动力学参数的差异.根据ROC曲线选择预测T RAS的最佳血流动力学参数及截断值,并计算其敏感性及特异性.经Logistic回归筛选T RAS的独立预测指标.结果 与非狭窄组相比,狭窄组肾主动脉收缩期峰值流速(PSV)、肾主动脉 PSV／叶间动脉 PSV (即峰值流速后比)及叶间动脉的加速时间(AT)增高,叶间动脉PSV降低(均 P ＜0 .05) .肾主动脉PSV为 218 .5 cm／s ,叶间动脉PSV为 25 .5 cm／s ,峰值流速后比为7 .2 ,叶间动脉AT为67 .5 ms时,预测儿童TRAS的敏感性及特异性最高,可作为筛查儿童TRAS的超声阈值.叶间动脉PSV可作为TRAS的独立预测指标.结论 彩色多普勒超声评估移植肾各级动脉血流动力学改变对预测儿童T RAS具有临床实用价值.%Objective To explore the value of color Doppler ultrasonography in diagnosis of transplant renal artery stenosis( TRAS) of children . Methods The results of ultrasound examination and clinical data of 82 kidney transplant children with suspected TRAS were retrospectively analyzed . According to the results of the CTA ,the enrolled children were divided into a stenosis group with 21 cases and a non-stenosis group with 61 cases . The differences of ultrasound hemodynamic parameters between the two groups were compared . The hemodynamic parameters and cutoff values of prediction of TRAS were determined according to the ROC curve ,and the corresponding sensitivity and specificity were calculated . Logistic regression was used to screen TRAS independent predictors . Results Compared with the non-stenosis group ,the peak systolic velocity ( PSV ) of the renal aorta ,the renal aorta PSV/interlobular artery PSV ( post PSV ratio ) and acceleration time ( AT ) of interlobular artery in the stenosis group were significantly higher ,but the PSV of the interlobular artery was lower ( all P ＜ 0 .05 ) . Differences of indicators between the two groups can be used to predict TRAS . Through the ROC curve the peak systolic velocity of the renal aorta and the interlobular artery were 218 .5 cm/s and 25 .5 cm/s ,respectively ,the post PSV ratio was 7 .2 ,and the AT of intervein arterial was 67 .5 ms ,the sensitivity and specificity were the highest ,which could be used as the ultrasound screening threshold . The PSV of the interlobular artery can be used as an independent predictor of TRAS . Conclusions Analysis of hemodyamic parameters of transplanted kidney arteries by Doppler ultrasonography might be useful in predicting TRAS in children .