| 摘要: |
| 摘要：目的 探讨二维剪切波弹性成像技术（2D-SWE）对慢性肾脏病（CKD）的诊断价值及其影响因素。方法 分别对114例CKD患者和31例健康者体检者测量肾脏剪切波速度( shearwavevelocity , SWV )、像素强度和叶间动脉阻力指数（RI）。CKD患者依据K/DOQI分级标准分为1～5期组，分析比较三种超声参数在CKD不同分组内与健康体检者间的差异，以及绘制ROC曲线比较各技术诊断CKD的性能，通过步进回归分析可能影响2D-SWE的因素。结果 CKD患者SWV均低于健康体检者，肾脏像素强度与叶间动脉RI均高于健康体检者（均p<0.05），且SWV随着CKD分期增加而逐渐下降，而像素强度与叶间动脉RI随之不断升高，三种参数在不同组间的差异均有统计学意义（均p<0.001）。在对早期CKD患者的诊断中，2D-SWE有显著诊断意义（p<0.001），左肾皮质SWV在小于1.13m/s时诊断敏感度高达81.8%，右肾皮质SWV在小于1.16m/s时特异性高达90.0%，且2D-SWE的AUC面积大于像素强度与叶间动脉RI的AUC面积（均p<0.05），而叶间动脉RI与像素强度间无诊断差异（p>0.05)。对中晚期CKD患者的诊断中，2D-SWE、像素强度与叶间动脉RI均有诊断意义（均p<0.001），且2D-SWE与像素强度的曲线面积均大于叶间动脉RI（均p<0.05)，但是2D-SWE与像素强度间无诊断差异（均p>0.05)。步进回归分析结果提示收缩压、叶间动脉RI、像素强度与β2微球蛋白是SWV降低的影响因素。结论2D-SWE、超声直方图与叶间动脉RI均对CKD有一定的诊断价值，但对早期CKD患者的诊断2D-SWE优于超声直方图与叶间动脉RI，其可能为早期诊断CKD、动态监测疾病进展、评估疗效及预后提供新方法。 |
| 关键词: 慢性肾脏病 二维剪切波弹性成像 超声直方图 叶间动脉阻力指数 |
| DOI： |
| 投稿时间：2021-05-27修订日期：2021-07-11 |
| 基金项目: |
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| Evaluation of two-dimensional shear wave elastography in the diagnosis of chronic kidney disease |
| gaoqi,chen songwang,jiang cui ping |
| () |
| Abstract: |
| Abstract: Objective To investigate the diagnostic value of 2D shear wave elastography (2D-SWE) in chronic kidney disease (CKD) and its influencing factors. Methods Renal shearwavevelocity (SWV), pixel intensity and interlobar artery resistance index (RI) were measured in 114 CKD patients and 31 healthy subjects.CKD patients were divided into stage 1 to 5 groups according to K/DOQI grading standard. The differences of three ultrasonic parameters in different groups of CKD were analyzed and compared with those in healthy subjects.The ROC curve was drawn to compare the performance of each technique in the diagnosis of CKD.Results The SWV of CKD patients were lower than that of healthy subjects, and the pixel intensity and RI of renal interlobar artery were higher than those of healthy subjects (all P<0.05), and SWV decreased gradually with the increase of CKD stage, while pixel intensity and interlobar RI increased continuously.The differences of the three parameters among different groups were statistically significant (all P <0.001).In the diagnosis of patients with early CKD, 2D-SWE was significant (P<0.001). The diagnostic sensitivity of left cortical SWV was up to 81.8% when it was less than 1.13m/s, and the specificity of right cortical SWV was up to 90.0% when it was less than 1.16m/s.Moreover, the AUC area of 2D-SWE was larger than that of pixel intensity and interlobar artery RI (both P <0.05), and there was no diagnostic difference between interlobar artery RI and pixel intensity (P>0.05).In the diagnosis of patients with advanced CKD, 2D-SWE, pixel intensity and interlobar artery RI were all of diagnostic significance (all P <0.001), and the curve area of 2D-SWE and pixel intensity was greater than that of interlobar artery RI (all P <0.05), but there was no diagnostic difference between 2D-SWE and pixel intensity (all P >0.05). Stepwise regression analysis showed that systolic blood pressure, RI, pixel intensity and β2 microglobulin were the influencing factors of SWV decrease.Conclusions 2D-SWE, ultrasound histogram and interlobular artery RI have certain diagnostic value for CKD, but 2D-SWE is superior to ultrasound histogram and interlobular artery RI in the diagnosis of early CKD patients. It may be an early diagnosis of CKD, Dynamic monitoring of disease progression, evaluation of curative effect and prognosis provide new methods. |
| Key words: Chronic kidney disease Two-dimensional shear wave elastography grayscale histogram Interlobar arterial resistance index |
