摘要
目的：分析肾组织弹性成像与慢性肾脏病（CKD）患者的临床和病理改变的相关性，探讨其能否成为动态监测肾脏疾病进展、评估疗效及预后的新方法。方法选取中国医科大学附属第一医院2014年8月？2015年1月住院治疗并行肾活检的患者113例，其中男性61例，女性52例，IgA肾病23例，膜性肾病39例，微小病变型肾病15例，局灶节段性肾小球硬化症7例。采用全数字化彩色多普勒超声诊断仪进行肾组织实时剪切波超声弹性成像检查，检测肾皮质、髓质的杨氏模量（YM 皮质、YM 髓质）。统计学分析CKD患者YM 皮质、YM 髓质与血液、尿液临床和生化指标的相关性，及不同病理类型、不同分期CKD患者YM 皮质、YM 髓质的差异。结果各期CKD患者YM 皮质、YM 髓质均高于健康对照组（均P＜0.05），随着CKD的进展，YM 皮质、YM 髓质逐渐升高；CKD G5期患者YM 皮质均高于CKD G1？3期患者（均P＜0.05），CKD G3？5期患者YM 髓质均高于CKD G1？2期患者（均P＜0.05）。YM 皮质与收缩压、血清肌酐、胱抑素C、血清白蛋白（ALB）、血磷、钙磷乘积、尿酸、全段甲状旁腺素（iPTH）、尿NAG、肾小球滤过率估算值（eGFR）、血红蛋白相关（均P＜0.05）。YM 髓质与收缩压、血清肌酐、血清ALB、尿酸、iPTH、尿微量白蛋白（MA）、尿NAG、血红蛋白相关（均P＜0.05）。血清胱抑素C（β=0.485，P=0.018）、尿酸（β=0.418，P=0.039）是YM皮质升高的独立危险因素，血清肌酐（β=0.380，P=0.019）、血尿酸（β=0.482，P=0.004）、吸烟（β=0.337，P=0.009）是YM髓质升高的独立危险因素。不同病理型CKD患者YM 皮质、YM 髓质比较差异均有统计学意义（P值分别为＜0.001、0.003）。膜性肾病、IgA肾病患者的YM 皮质、YM 髓质均高于微小病变型肾病患者（均P＜0.05）；局灶节段性肾小球硬化症患者YM 髓质高于微小病变型肾病患者（P＜0.05）。IgA肾病Lee分级Ⅳ、Ⅴ级患者YM 皮质、YM 髓质均高于Ⅱ？Ⅲ级患者（均P＜0.05）。IgA肾病牛津分型T1、T2组患者YM 皮质、YM 髓质均高于T0组患者（均P＜0.05）。不同分期膜性肾病患者YM 皮质、YM 髓质差异均没有统计学意义。结论YM 皮质、YM 髓质与肾功能不全的进展相关，其可能成为鉴别CKD进展和肾组织纤维化程度新的诊断指标，并为早期诊断CKD、动态监测疾病进展、评估疗效及预后提供新方法。
Objective To analyze how is the elastography of renal tissue correlated to clinical biochemical indexes and pathological changes in patients with chronic kidney disease （CKD）, and toexplore the potential of renal elastography to become a new noninvasive method available for the dynamic monitoring of renal disease progression, as well as its efficacy assessment and prognosis evaluation. Methods Patients admitted to the department of nephrology of the First Affiliated Hospital of China Medical University and received renal biopsy from August 2014 to January 2015 were selected. One hundred and thirteen cases of CKD patients, 61 males and 52 females were enrolled, including 23 cases of IgA nephropathy, 39 cases of membranous nephropathy, 15 cases of minimal change nephropathy and 7 cases of focal segmental glomerulosclerosis. The Young modulus of renal cortex and medulla （YMcortex and YMmedul a） were detected by Aix Plorer type full digital color Doppler ultrasound. The correlations between the YMs and clinical biochemical indicators in blood and urine, and the difference of YMs among different pathological changes in patients with CKD were analyzed by statistics. Results The YMcortex and YMmedul a in CKD patients were higher than those in the control group （all P〈0.05）; and with the progression of CKD, the YMcortex and YMmedul a gradually increased. The YMcortex in CKD G5 patients was higher than that in CKD G1？3 patients （all P〈0.05）. The YMmedul a in CKD G3？5 patients was higher than that in CKD G1？2 patients （all P〈0.05）. The YMcortex was correlated with systolic pressure, serum creatinine, cystatin C, serum albumin, serum phosphorus, calcium and phosphorus product, uric acid, intact parathyroid hormone （iPTH）, urinary NAG, estimate glomerular filtration rate （eGFR） and hemoglobin （all P〈0.05）. The YMmedul a was correlated with systolic pressure, serum creatinine, serum albumin, uric acid, iPTH, urine microalbumin （MA）, urinary NAG and hemoglobin （all P〈0.05）. Serum cystatin C （β=0.485, P=0.018） and uric acid （β=0.418, P=0.039） were independently correlated with the YMcortex. Serum creatinine （β=0.380, P=0.019）, uric acid （β=0.482, P=0.004） and smoking （β=0.337, P=0.009） were independently correlated with YMmedul a. The YMcortex and YMmedul a in different pathological types were statistically significant （P〈0.001, P=0.003）. The YMcortex and YMmedul a in patients with membranous nephropathy and IgA nephropathy were higher than those in the patients with minimal change nephropathy （all P〈0.05）. The YMmedul a in patients with focal segmental glomerulosclerosis was higher than that in the patients with minimal change nephropathy （P〈0.05）. The YMcortex in the patients with phases Ⅳ and Ⅴ based on the Lee grading system of IgA nephropathy was higher than that in the patients with phases Ⅱ andⅢ （P〈0.05）. According the Oxford classification for IgA nephropathy, the YMcortex and YMmedul a in the T1 and T2 patients were higher than those in the T0 patients （P〈0.05）. The YMcortex and YMmedul a showed no statistically significant differences among different stages of membranous nephropathy. Conclusions The YMcortex and YMmedul a are associated with the progress of renal insufficiency, which may become new indicators for determining CKD progression. The renal ultrasound elastography may become a new non？invasive method for early diagnosing CKD, dynamic monitoring disease progression, and assessing efficacy and prognosis.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2016年第7期481-486,共6页
Chinese Journal of Nephrology
基金
国家自然科学基金（81270808）
沈阳市科学计划项目（F16-205-1-40）
辽宁省高等学校重大科技平台免疫皮肤病学重点实验室自主创新课题基金（201303）
