超声造影定量技术评估单侧输尿管梗阻大鼠肾髓质血流灌注的变化

摘要

目的：采用超声造影（ CEUS）定量技术评估单侧输尿管梗阻（ UUO）大鼠肾髓质血流灌注的变化。方法建立大鼠UUO模型19只，采用CEUS及定量分析技术检测造模前后双侧肾髓质血流灌注，并行病理检查。结果造模后梗阻侧肾髓质较造模前血流灌注速度减慢，造影剂廓清时间延长，但增强程度变化不大；健侧肾髓质较造模前血流灌注速度、强度及造影剂廓清时间变化不大。造模前后梗阻侧肾髓质血流灌注时间-强度曲线中达峰时间（TTP）分别为（25．59±3．92）、（28．48±4．67）s，曲线下面积（AUC）分别为（905．46±271．90）、（1010．54±309．11）dB· s，曲线上升支斜率（A）分别为（1．04±0．59）、（0．87±0．41）dB/s，P均＜0．05。造模前后健侧肾髓质TTP、AUC、A、峰值强度（PI）比较， P均＞0．05。梗阻侧肾脏近曲小管及远曲小管均出现不同程度的扩张，肾间质水肿增宽，并出现单核巨噬细胞、淋巴细胞的浸润，偶见肾小管萎缩。结论 UUO大鼠梗阻侧肾髓质局部组织的血流灌注速度降低，血管内血流容积增大；CEUS及定量分析技术能较好地检测UUO大鼠肾髓质血流灌注的变化。%Objective To evaluate the renal medulla blood perfusion characteristics in rats with unilateral ureteral ob -struction (UUO) by using contrast-enhanced ultrasound (CEUS) and quantitative analysis technique .Methods Nineteen UUO rat models were established , and the bilateral renal medullary perfusion before and after the UUO operation was detec -ted by using CEUS and quantitative analysis technique , meanwhile , pathology examination was performed .Results After modeling , the blood perfusion velocity of the obstructed kidney medulla was slower than before modeling , the contrast agent washout time was prolonged , but the enhancement degree changed little;while, the blood perfusion velocity , intensity and contrast agent washout time changed little before and after the modeling of the normal renal medulla .Quantitative analysis showed that the preoperative and postoperative blood perfusion time to peak ( TTP) in the obstructed kidney medulla were (25.59 ±3.92) and (28.48 ±4.67)s, area under curve (AUC) were (905.46 ±271.90) and (1 010.54 ±309.11) dB · s, and slope rate of ascending curve (A) were (1.04 ±0.59) and (0.87 ±0.41)dB/s, respectively (all P<0.05). No significantly differences were found in TTP, AUC, A and PI of the normal renal medulla (P>0.05).The obstructed renal proximal tubule and distal convoluted tubules showed varying degrees of expansion , broadening renal interstitial ede-ma, and infiltration of mononuclear macrophage and lymphocyte , occasionally tubular atrophy .Conclusions The obstruc-ted renal medulla blood perfusion velocity of UUO rats decreases and intravascular blood volume increases .CEUS and quantitative analysis technique may effectively detect the changes of renal medulla perfusion in UUO rats .