2018 年第 2 期 第 13 卷

多普勒超声检测的肾叶间动脉收缩期峰值血流速度和阻力指数与慢性肾功能不全程度的相关性

作者：秦淮赵昶程颐赵青郑烨

英文作者：

单位：100029首都医科大学附属北京安贞医院综合超声科

英文单位：

关键词：慢性肾功能不全；收缩期峰值血流速度；阻力指数；超声多普勒

英文关键词：

• 摘要：

• 目的    探讨多普勒超声检测的肾叶间动脉收缩期峰值血流速度和阻力指数与慢性肾功能不全程度的相关性。方法    选取2014年9月至2016年7月首都医科大学附属北京安贞医院肾内科肾功能不全住院患者134例为慢性肾功能不全组，依据血肌酐值及肾小球滤过率（GFR）分为Ⅰ组（15例）、Ⅱ组（101例）、Ⅲ组（9例）、Ⅳ组（9例）（肾贮备功能下降期、氮质血症期、肾衰竭期、尿毒症期），选取同期肾功能正常患者51例作为对照组。采用彩色多普勒超声诊断仪测量肾叶间动脉收缩期峰值血流速度(PSV)和阻力指数，同时所有研究对象检测血肌酐、尿素氮、尿酸和尿α1微球蛋白（α1-MG）水平，组间做比较。采用Pearson相关分析PSV和阻力指数与慢性肾功能不全严重程度的相关性。结果    5组患者彩色超声多普勒血流动力学参数（PSV、阻力指数）及血肌酐、尿素氮、尿酸、尿α1-MG水平差异有统计学意义（P<0.05）。随着肾损害加重，PSV呈下降趋势，阻力指数呈升高趋势。在肾功能不全早期（Ⅰ组），阻力指数升高，而PSV未见减低；在肾功能不全晚期（Ⅲ组），阻力指数升高，PSV明显减低；其中Ⅱ、Ⅲ、Ⅳ组PSV明显低于对照组［（33±17）、（23±10）、（23±11）cm/s比（43±17）cm/s］，Ⅰ、Ⅱ、Ⅲ、Ⅳ组阻力指数明显高于对照组［（0.63±0.06）、（0.70±0.07）、（0.73±0.09）、（0.77±0.09）比（0.60±0.07）］（均P<0.05）。相关性分析结果显示PSV与肾功能不全程度呈负相关（r=-0.372、P<0.001），阻力指数与肾功能不全程度呈正相关（r=0.491、P<0.001）。结论    肾损害越重，PSV越低，阻力指数越高。阻力指数对于早期发现肾功能损害具有重要意义，阻力指数结合PSV对于肾衰竭的诊断更有意义。

• Correlation of renal interlobular artery peak systolic velocity and resistance index detected by Doppler ultrasonography with chronic renal insufficiency

  Qin Huai, Zhao Chang, Cheng Yi, Zhao Qing, Zheng Ye

  Department of Ultrasonography, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China

  Corresponding author: Zhao Chang, Email: bj1118@163.com

  【Abstract】Objective    To investigate the correlation of renal interlobular artery peak systolic velocity(PSV) and resistance index(RI) detected by Doppler ultrasonography with chronic renal insufficiency. Methods    One hundred and thirty-four in-hospital patients with chronic renal insufficiency admitted in Department of Nephrology, Beijing Anzhen Hospital, Capital Medical University from September 2014 to July 2017 were enrolled as renal insufficiency group, and these patients were divided into group Ⅰ(renal function descent, n＝15), group Ⅱ(azotemia, n＝101), group Ⅲ(renal failure, n＝9) and group Ⅳ(uremia, n＝9) according to levels of creatinine and glomerular filtration rate(GFR). Fifty-one patients with normal renal function were enrolled as control group. Renal interlobular artery PSV and RI were measured by color Doppler ultrasonography. Levels of serum creatinine, urea nitrogen, uric acid and urine α1 microglobulin(α1-MG) were tested. Correlations of PSV, RI and the severity of renal insufficiency were analyzed by Pearson analysis. Results    Doppler hemodynamic parameters（PSV and RI） and urine biochemical indicators （serum creatinine, urea nitrogen, uric acid and urine α1-MG） showed significant differences among 5 groups(P<0.05). PSV decreased and RI increased with renal injury severity. PSV in group Ⅱ, Ⅲ, Ⅳ was significantly lower than that in control group［（33±17）,（23±10）,（23±11）cm/s vs （43±17）cm/s］; RI in group Ⅰ, Ⅱ, Ⅲ, Ⅳ was significantly higher than that in control group［（0.63±0.06）,（0.70±0.07）,（0.73±0.09）,（0.77±0.09） vs （0.60±0.07）］（P<0.05）. Pearson analysis showed that PSV was negatively correlated with the severity of renal insufficiency(r=-0.372, P<0.001), and RI was positively correlated with the severity of renal insufficiency(r=0.491, P<0.001). Conclusions    PSV decreases and RI increases with the severity of renal insufficiency. RI is sensitive in early detection of renal impairment. Combined detection of RI and PSV is valuable diagnosis of renal failure.

  【Key words】Chronic renal insufficiency;Peak systolic velocity;Resistance index;Doppler ultrasonography