CAJ | 학술논문

目的：采用肾脏大小、髓质回声、血流灌注等多种超声参数的评分来探讨其在急性肾功能衰竭中诊断及与慢性肾功能衰竭鉴别诊断的价值。方法171例患者分成4组，即急性肾功能衰竭组、慢性肾功能衰竭组、肾功能正常的肾病组和正常对照组，观察4组患者的肾脏大小、形态(藕片征)、血流(烟花征)等指标，采用评分法，用 ROC 曲线下面积寻求一个最佳的诊断界值。结果肾皮质回声增强、髓质回声减低，形成藕片征是急性肾功能衰竭的特征性改变，能很好地对急性肾功能衰竭与慢性肾功能衰竭的患者进行鉴别；肾血流灌注虽与血肌酐呈负相关，但在急性肾功能衰竭和慢性肾功能衰竭仍有较大区别，急性肾功能衰竭者血流减少相对较轻多为1级和2级，表现为烟花征，而慢性肾功能衰竭多为3级和4级；肾脏增大为急性肾功能衰竭，缩小为慢性肾功能衰竭，正常大小鉴别无意义。对于非糖尿病的肾功能衰竭患者，综合评分≥10分，诊断为急性肾功能衰竭，敏感度83.7%，特异度95.6%。结论超声多参数分析，对于诊断急性肾功能衰竭尤其是肾脏大小正常患者有重要价值。
목적：채용신장대소、수질회성、혈류관주등다충초성삼수적평분래탐토기재급성신공능쇠갈중진단급여만성신공능쇠갈감별진단적개치。방법171례환자분성4조，즉급성신공능쇠갈조、만성신공능쇠갈조、신공능정상적신병조화정상대조조，관찰4조환자적신장대소、형태(우편정)、혈류(연화정)등지표，채용평분법，용 ROC 곡선하면적심구일개최가적진단계치。결과신피질회성증강、수질회성감저，형성우편정시급성신공능쇠갈적특정성개변，능흔호지대급성신공능쇠갈여만성신공능쇠갈적환자진행감별；신혈류관주수여혈기항정부상관，단재급성신공능쇠갈화만성신공능쇠갈잉유교대구별，급성신공능쇠갈자혈류감소상대교경다위1급화2급，표현위연화정，이만성신공능쇠갈다위3급화4급；신장증대위급성신공능쇠갈，축소위만성신공능쇠갈，정상대소감별무의의。대우비당뇨병적신공능쇠갈환자，종합평분≥10분，진단위급성신공능쇠갈，민감도83.7%，특이도95.6%。결론초성다삼수분석，대우진단급성신공능쇠갈우기시신장대소정상환자유중요개치。
Objective To explore the values of scoring kidney size,medulla echo,blood perfusion and other ultrasound parameters in the differential diagnosis of acute and chronic kidney failure.Methods Forty-three cases of acute renal failure,forty-five cases of chronic renal failure,forty-three cases of kidney disease with normal renal function and forty cases of healthy controls were enrolled in this study.Size of kidney,form (lotus-root sign),blood flow (firework sign)and other indicators were observed and scored.Then,the scores of the parameters were used to draw ROC curve for seeking an optimal diagnostic cutoff.Results The renal cortex echo enhancement and medulla echo reduction,forming a lotus root sign,were characteristic changes of acute renal failure for distinguishing acute kidney failure from the chronic.Although blood perfusion in kidney was negatively correlated with creatinine in kidney failure,the reduction of blood flow showing as firework sign was mostly acute renal failure in class Ⅰ and Ⅱ,while chronic renal failure was mostly in class Ⅲ and Ⅳ.The size of kidney increased in acute renal failure but decreased in chronic renal failure.However,the normal size of kidney was meaningless for the differential diagnosis.For patients with renal failure but without diabetics,total score ≥ 10 can be used to diagnose acute kidney failure with a sensitivity of 83.7% and specificity of 95.6%.Conclusion Multi-parameter analysis of renal ultrasound plays an important role in the diagnosis of acute renal failure,especially for the patients with normal size of the kidney.