声脉冲辐射力成像与慢性肾脏疾病分期和估算肾小球滤过率的相关性研究

摘要

目的 探讨声脉冲辐射力成像(acoustic radiation force impulse, ARFI)在预测慢性肾脏疾病(chronic kidney disease,CKD)临床分期以及肾脏纤维化程度中的应用价值.方法 选取2016年3-12月在成都军区总医院行ARFI检查的CKD不同临床分期患者共48例,所有患者均经病理结果证实肾病病理类型.根据CKD临床分期及估算肾小球滤过率(estimated glomerular filtration rate, eGFR)=60 mL·min-1·1.73m-2作为标准,将患者分为5组(CKD 1~5期)和两组(eGFR<60 mL·min-1·1.73m-2,eGFR≥60 mL·min-1·1.73m-2).应用ARFI测量所有患者肾皮质剪切波速(shear wave velocity, SWV),并对不同分组进行比较,Spearman分析CKD患者肾皮质弹性变化与临床分期、病理纤维化程度、肌酐、尿素氮、肾脏长径等相关性,ANOVA分析CKD各组间SWV值.结果 随着CKD分期加重,SWV值增大,CKD4期和5期患者SWV值最大,分别为(2.51±0.50)m/s和(2.51±0.00)m/s; GFR<60 mL·min-1·1.73m-2组SWV值为(2.29±0.40)m/s,GFR≥60 mL·min-1·1.73m-2组SWV值为(2.30±0.40)m/s.Spearman相关分析显示,CDK患者肾皮质SWV值与CKD临床分期、病理纤维化程度、肌酐、尿素氮、肾脏长径等的相关性差异无统计学意义(P>0.05). ANOVA分析显示,CKD各临床分期间,SWV值差异无统计学意义(P>0.05).结论 SWV值随着CKD的严重程度而增加,但仍不足以作为预测CKD的分期和肾脏纤维化程度的方法.%Objective To explore the application values of acoustic radiation force impulse imaging (ARFI) in predicting the staging of chronic kidney disease (CKD) and the degree of renal tissue fibrosis. Methods 48 CKD patients of different stages undergoing the examination of ARFI from March to December of 2016 were selected in the study and the pathological types of all the patients were confirmed as nephropathy by the pathological results. Those patients were divided into five stages from Stage 1 to Stage 5 according to the CKD clinical staging. In accordance with the standard of Estimated Glomerular Filtration Rate (eGFR)=60 mL·min-1·1.73m-2, those patients were also divided into the group with eGFR<60 mL·min-1·1.73m-2 and the group with eGFR≥60 mL·min-1·1.73m-2. The shear wave velocity (SWV) of renal cortex in each group was detected by ARFI and compared among different stages and groups. The Spearman correlation analysis was adopted to analyze the correlation of renal cortical elasticity of CKD patients with the indicators such as clinical stage, pathological fibrosis degree, serum creatinine, urea nitrogen, and kidney size respectively. The SWV differences of each group were analyzed by One-way ANOVA. Results The SWV value increased with the aggravation of CKD, and the SWV values of CKD Stage 4 and 5 were the highest and they were(2.51±0.50)m/s and(2.51±0.00)m/s respectively. The SWV value of the group with eGFR<60 mL·min-1·1.73m-2 was (2.29±0.40)m/s, while that of the group with eGFR≥60 mL·min-1·1.73m-2(2.30±0.40)m/s. The results of Spearman correlation analysis showed that the SWV values of renal cortex of CDK patients were not correlated with the indicators including the clinical stage of CKD, pathological fibrosis degree, serum creatinine, urea nitrogen, and kidney size (P>0.05). The results of One-way ANOVA showed that there were no significant differences in the SWV value among all the stages of CKD (P>0.05). Conclusion The SWV value increases with the aggravation of CKD, but it cannot be taken as the method to predict the clinical stage of CKD and the renal tissue fibrosis.