超声造影评价慢性肾小球肾炎治疗前后肾脏微循环改变

摘要

目的 探讨超声造影定量分析新技术在评价临床慢性肾衰患者治疗前后肾脏微循环变化之可能性及临床价值.方法 收集我院肾内科提供参加药物(药物名暂不公开)实验的慢性肾小球肾炎(chronic glomerulonephritis,CGN)患者20例.采用西门子S2000超声仪器分别于用药前及用药后对患者右肾肾皮质进行实时灰阶超声造影灌注成像,使用超声微泡造影剂为声诺唯(Bracco SonoVue),选取肾脏皮质中的感兴趣区(region of interest,ROI),通过软件绘制时间-强度曲线,得到相关的定量参数如曲线下面积(area under curve,AUC)、峰值强度(peak intensity,PI)、达峰时间(time to peak,TTP)、平均通过时间(mean transit time,MTT)等.同时测各时间点24 h尿蛋白定量(urinary protein quantitative,NDBDL)、尿蛋白质计数(urine protein count,PRO)、血肌酐(serum creatinine,Scr)及血尿素氮(blood urea nitrogen,BUN),分析其与超声造影各参数的相关性.结果 治疗后患者的24 h尿蛋白定量减少或增多时,肾血流灌注参数,特别是肾皮质部血流灌注参数也会相应出现明显改变,其造影参数AUC的改变与患者的慢性肾小球肾炎患者的24 h尿蛋白定量的改变存在线性相关性.结论 超声造影定量分析新技术可较敏感反映慢性肾小球肾炎治疗前后肾皮质部微血管血流灌注变化特点,该技术可作为临床早期检测慢性肾炎患者肾脏微循环变化首选手段.%Objective To evaluate the feasibility and clinical value of contrast-enhanced ultrasonography(CEUS) in quantitative analysis renal function changes with chronic renal failure.Methods 20 cases of clinical confirmed chronic glomerulonephritis (CGN) patients in our urology department were included in our research.After intravenous bolus injection of SonoVue,real time CEUS of renal cortex blood perfusion were collected successively,and a time-intensity curve (TIC) were created with Siemens S2000 system's.QLAB software.Changes of area under curve (AUC),peak intensity (PI),time to peak (TTP) and mean transit time (MTT) were obtained.Urinary protein quantitative (NDBDL),urine protein count (PRO),serum creatinine (Scr) and blood urea nitrogen (BUN) were collected at the same time.Their correlations with time-intensity curve of each parameter value were analysed.Results With the reducing or increasing of 24 hours of urinary protein quantitative and urine protein count,the renal blood flow perfusion parameters,especially the renal cortex blood perfusion parameters were also appear obvious corresponding change,and the time-intensity curve quantitative parameters AUC was significantly correlated with urinary protein quantitative.Conclusions Quantitative analysis of the CEUS can sensitively reflect the change of renal cortical perfusion in chronic glomerulonephritis patients.It can be used as preferred technology to early detect the change of renal microcirculation in chronic nephritis patients.