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| 剪切波弹性成像评估腹膜透析华患者腹膜硬化程度的应用价值 |
| 张雨彤,陈瑜君,李晓菊,王晓莉,李蔓英,谢晓燕,徐明 |
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| (中山大学附属第一医院超声医学科 中山大学超声诊断与介入超声研究所) |
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| 摘要: |
| 目的 探讨长期腹膜透析病人腹部的普通超声和剪切波弹性成像(Shear wave elastic imaging, SWE)图像特点及其在评估腹膜硬化(Peritoneal sclerosis)严重程度中的可行性。方法 对不同腹透时间的持续非卧床腹膜透析(Continuous ambulatory peritoneal dialysis,CAPD)患者分别行普通超声和弹性超声检查,观察肠壁厚度,肠壁钙化,腹膜钙化,包裹性腹水程度、肠扩张等普通超声指标,将各普通超声指标量化为超声表现评分,并测量肠壁、腹膜弹性值等弹性指标。分析并验证超声综合表现评分、弹性指标与腹膜硬化严重程度关系。结果 CAPD患者按照不同腹透时间分为三组：≤3年(n=71)、4-10年(n=78)、≥11年(n=19)。普通超声下腹透患者随透析时间延长具有特征性超声表现：肠壁增厚、肠壁钙化、腹膜增厚、腹膜钙化、包裹性腹水。且增厚的肠壁、肠壁钙化、腹膜钙化主要发生在腹透管末端周围。三组患者超声综合表现评分分别为0(0,0)、1(0,2)、2(0,3),肠壁弹性分别为4.9(3.5,7.4)KPa、9.9(6.3,14.1)KPa、11.4(6.5,20.9)KPa,腹膜弹性分别为7.5(5.7,8.9)KPa、11.9(6.5,18.6)KPa、20.3(11.0,30.4)KPa,上述超声指标随着透龄的增长而增加,差异具有统计学意义(P＜0.05)。相关分析结果显示,三者与透析时间呈正相关,相关系数分别为0.4684、0.3704、0.5844,P值小于0.05,差异具有统计学意义。结论 长期腹膜透析患者有特异性超声表现,腹膜弹性可以更早期准确评估腹膜硬化严重程度,用于协助评估和持续监测腹膜透析患者的腹膜状态,及早干预有利于改善患者预后。 |
| 关键词: 腹膜硬化 剪切波弹性成像 超声评估 腹膜透析 慢性肾衰 |
| DOI： |
| 投稿时间：2022-10-30修订日期：2023-01-06 |
| 基金项目:广东省医学科学技术研究(A2020160),国家自然科学基金面上项目(82071951) |
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| Clinical study of real-time shear-wave elastography ultrasound in evaluating the severity of peritoneal sclerosis in peritoneal dialysis patientsZhang Yutong, Chen Yujun, Li Xiaoju, Wang Xiaoli, Li Manying,Xie Xiaoyan, Xu Ming |
| zhangyutong,chenyujun,lixiaoju,wangxiaoli,limanying,xiexiaoyan,xuming |
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| Abstract: |
| Objective To investigate the characteristics of conventional ultrasound and shear wave elastography images of the abdomen of patients on long-term peritoneal dialysis and their feasibility in assessing the severity of peritoneal sclerosis. Methods Patients with Continuous ambulatory peritoneal dialysis (CAPD) with different duration of peritoneal dialysis were examined by ordinary ultrasound and elastic ultrasound respectively. The intestinal wall thickness, intestinal wall calcification, peritoneal calcification, degree of encapsulated ascites, intestinal dilatation and other common ultrasound indicators were observed. Each common ultrasound index was quantified as ultrasound performance score, and the elasticity of intestinal wall and peritoneum was measured. To analyze and verify the relationship between ultrasound comprehensive performance score, elasticity index and the severity of peritoneal sclerosis. Results Patients on continuous ambulatory peritoneal dialysis were divided into three groups according to different duration of abdominal dialysis: ≤3 years (n=71), 4-10 years (n=78), and ≥11 years (n=19). Patients with abdominal dialysis under conventional ultrasound had characteristic ultrasound manifestations with increasing dialysis duration: thickened intestinal wall, intestinal wall calcification, thickened peritoneum, peritoneal calcification, and encapsulated ascites. The thickened intestinal wall, intestinal wall calcification, and peritoneal calcification mainly occurred around the end of the peritoneal dialysis tubing. The combined ultrasound performance scores were 0 (0, 0), 1 (0, 2), 2 (0, 3), the intestinal wall elasticity was 4.9 (3.5, 7.4)KPa, 9.9 (6.3, 14.1)KPa, 11.4 (6.5, 20.9)KPa, and the peritoneal elasticity was 7.5 (5.7, 8.9)KPa, 11.9 (6.5, 18.6)KPa, 20.3 (11.0, 30.4)KPa, the above ultrasound indexes increased with the increase of the penetration age, and the difference was statistically significant (P < 0.05). The results of correlation analysis showed that the three factors were positively correlated with dialysis time, and the correlation coefficients were 0.4684, 0.3704 and 0.5844, respectively. The P value was less than 0.05, and the difference was statistically significant. Conclusions Patients with long-term peritoneal dialysis have specific ultrasound manifestations. Peritoneal elasticity can accurately assess the severity of peritoneal sclerosis at an earlier stage, which can be used to assist in evaluating and continuously monitoring the peritoneal status of patients with peritoneal dialysis. Early intervention is beneficial to improve the prognosis of patients. |
| Key words: Peritoneal sclerosis Shear wave elastography Ultrasound evaluation Peritoneal dialysis Chronic renal failure |
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