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| 肾脏超声评分联合多普勒超声预测慢性肾脏病患者肾功能减低的临床价值 |
| 谭团团,冯闯丽,胡玉刚,黄魁,高翾,陈婷,焦丽娟,崔成媛,冯茜雅,曹省 |
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| (武汉大学人民医院超声影像科) |
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| 摘要: |
| 摘 要 目的 早期建立理想的风险评估模型是慢性肾脏病（CKD）防治的重点。超声参数具有快速、可重复和易于获取的优势，本文旨在探讨超声参数预测CKD患者肾损害程度，提高常规肾脏彩超检查筛选 CKD 高危人群的价值。方法 选取我院确诊为CKD住院患者252例，根据CKD的GFR分期分为CKD轻度减低组（G1~2期，83例）和CKD中度以上减低组（G3~5期，169例）。收集两组临床资料和实验室检查指标[包括预估肾小球滤过率（eGFR）、血肌酐（Cr）]；应用二维超声检测双肾获得肾脏长度、实质厚度和实质回声，多普勒超声检测肾内动脉阻力指数（RI），比较两组上述参数的差异。采用Logistic回归分析超声参数对CKD轻度损害和重度受损的预测能力；绘制受试者工作特征（ROC）曲线分析超声参数对CKD轻度受损和重度受损的诊断效能。结果 两组临床资料和超声参数比较，年龄、高血压和冠心病参数差异有统计学意义（P＜0.05），实验室指标eGFR、尿素、肌酐及所有超声参数两组间比较差异有显著性（P＜0.0001）。ROC曲线分析肾实质回声强度和超声CKD评分有较高的AUC（0.838 vs 0.820），预测CKD轻度损害的截断值为1.75和4.75；预测CKD重度损害的截断值为2.25和5.25。多因素logistic回归分析超声参数联合预测CKD患者轻度和重度减低的AUC分别为0.867，0.847（均P＜0.0001）。结论 超声参数可以独立预测CKD患者肾功能轻度和重度受损，其中超声CKD评分、实质厚度和实质回声指标价值相对更高；联合肾动脉RI参数，可提高其预测效能。 |
| 关键词: 慢性肾脏病 慢性肾病超声评分 肾小球滤过率 阻力指数 实质回声增强 |
| DOI： |
| 投稿时间：2024-03-15修订日期：2024-09-18 |
| 基金项目:No.2024AFB186，湖北省自然科学基金青年项目 |
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| The value of renal ultrasound score combined with Doppler ultrasound predicting reduced renal function in chronic kidney disease patients |
| TAN Tuantuan,FENG Chuangli,HU Yugang,HUANG Kui,GAO Xuan,CHEN Ting,JIAO Lijuan,CUI Chengyuan,FENG Xiya,Cao Sheng |
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| Abstract: |
| ABSTRACT Objective Early establishment of an ideal risk assessment model is the key point of the prevention and treatment of chronic kidney disease (CKD). There are advantages of ultrasound parameters which is rapid, repeatable and easy to obtain. This study aims to explore the value of ultrasound parameters in predicting the degree of renal damage in CKD patients, and to improve the screening of CKD high-risk population by conventional renal color Doppler ultrasound. Methods 252 CKD in-patients were selected and divided into mild CKD reduction group (G1-2 stage, 83 cases) and moderate/severe CKD reduction group (G3-5 stage, 169 cases). Clinical data and laboratory tests [including estimated glomerular filtration rate (eGFR) and serum creatinine (Cr)] were collected. Renal length, parenchymal thickness and parenchymal echo were measured by two-dimensional ultrasound, and intrarenal arterial resistance index (RI) was measured by Doppler ultrasound. The differences of above parameters between the two groups were compared. Logistic regression was used to analyze the predictive ability of ultrasound parameters for mild and severe CKD damage. The receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic efficacy of ultrasound parameters for mild and severe impaired CKD. Results There were significant differences in age, hypertension and coronary heart disease between the two groups (P < 0.05). There were significant differences in eGFR, urea, creatinine and all ultrasound parameters between the two groups (P < 0.0001). ROC curve analysis of renal parenchyma echo intensity and ultrasound CKD score had a high AUC (0.838 vs 0.820), and the cut-off values for predicting mild CKD damage were 1.75 and 4.75. The cut-off values for predicting severe CKD damage were 2.25 and 5.25, respectively. Multivariate logistic regression analysis showed that the AUC of combined ultrasound parameters in predicting mild and severe CKD were 0.867 and 0.847, respectively (both P < 0.0001). Conclusion Ultrasound parameters can independently predict mild renal function impairment in CKD patients, among which ultrasound CKD score and renal parenchyma echo index have relatively higher values. Combined with renal artery RI parameters, the prediction efficiency can be improved. |
| Key words: chronic kidney disease ultrasonographic chronic kidney disease score estimated glomerular filtration rate resistance index parenchymal echogenicity |
