移植肾肾动脉重度狭窄的彩色多普勒血流特点及误、漏诊分析

摘要

Objective To investigate the value of color Doppler US in diagnosing renal artery stenosis(RAS)in transplanted kidney.Methods The peak systolic velocity(PSV)of the renal artery,PSV of interlobar arteries,the post-PSV ratio,and the resistive index(RI)of the interlobar arteries were measured on color Doppler US in normal kidneys and in transplanted kidneys with RAS.Using DSA as the gold standard,the reasons for inaccuracy on color Doppler US in transplanted kidneys were recorded. Results There was significant difference in the PSV of renal artery,post-PSV ratio and RI of interlobar arteries between the normal control and the RAS groups(P<0.05).PSV of interlobar artery in the control group did not differ significantly from that of transplanted kidneys with 80%-90% RAS(P>0.05).There were two false positive and three false negative diagnoses on color Doppler US. The inaccuracy was related to limited sonographic window,congenital vascular dysplasia,vascular adaptability in young patients and glomerulonephritis of the transplanted kidney.Conclusions Color Doppler US is valuable for early diagnosis of RAS in renal transplant with some limitations.Using multiple parameters,multiple sections,and variable angle scanning can reduce the false positive and false negative rates.%　　目的探讨移植肾肾动脉重度狭窄的彩色多普勒血流特点，分析彩色多普勒超声诊断误诊、漏诊原因及对策。方法对照分析对照组及移植肾肾动脉重度狭窄组患者肾主动脉PSV、叶间动脉PSV、峰值流速后比及叶间动脉RI的组间及组内差异，以DSA为诊断金标准，分析彩色多普勒超声误诊、漏诊病例的原因及对策。结果肾主动脉PSV、峰值流速后比及叶间动脉RI 3个彩色多普勒血流参数组间及组内差异有统计学意义，P＜0.05，叶间动脉PSV在对照组与狭窄度80%~90%组之间差异无统计学意义，P＞0.05。入组病例超声诊断出现假阳性2例，假阴性3例，主要与超声检查局限性、肾主动脉先天发育异常、年轻患者血管代偿能力强、移植肾肾小球病变等原因有关。结论彩色多普勒超声是移植肾动脉狭窄筛查的重要影像学方法，对于典型声像图具有较高的诊断价值；超声检查具有局限性，多参数、多切面、多角度扫查有助于疾病的早期发现，有助于降低假阳性率及假阴性率。