CAJ | 학술논문

目的：探讨超声造影定量参数在鉴别诊断移植肾急性排异反应中的临床价值。方法移植肾患者67例，其中正常组30例，急性排异组（AR）26例，急性肾小管坏死组（ATN）11例，常规超声测量移植肾段间动脉收缩期峰值流速（PSV）和阻力指数（RI），超声造影结合时间－强度曲线定量分析叶间动脉、皮质和髓质的上升时间（RT）、达峰时间（TTP）、平均通过时间（mTT））以及皮质和髓质之间的上升时间差（ΔRTm‐c）和达峰时间差（ΔTTPm‐c），采用组内相关系数评价各造影定量参数的稳定性。结果与正常组比较，AR组的RI明显增高（P＜0.05），但AR组的RI与ATN组比较差异无统计学意义（P＞0.05），观察者内超声造影参数RT和TTP的稳定性较好（ICC＞07．5），急性排异组髓质的RT、TTP以及ΔRTm‐c和ΔTTPm‐c较ATN和正常组明显延长（P＜0.05）。ROC曲线分析显示5种参数诊断急性排异的准确性依次为ΔRTm‐c＞ΔTTPm‐c＞RTm＞TTPm＞RI（曲线下面积分别为07．86、07．56、07．49、07．36、04．98），ΔRTm‐c≥46．2s为截断值具有最高的诊断价值（敏感性和特异性分别为783．％和735．％）。结论超声造影定量参数可客观地反映移植肾不同状态的血流灌注，与常规超声比较，能更好地鉴别诊断移植肾急性排异。
목적：탐토초성조영정량삼수재감별진단이식신급성배이반응중적림상개치。방법이식신환자67례，기중정상조30례，급성배이조（AR）26례，급성신소관배사조（ATN）11례，상규초성측량이식신단간동맥수축기봉치류속（PSV）화조력지수（RI），초성조영결합시간－강도곡선정량분석협간동맥、피질화수질적상승시간（RT）、체봉시간（TTP）、평균통과시간（mTT））이급피질화수질지간적상승시간차（ΔRTm‐c）화체봉시간차（ΔTTPm‐c），채용조내상관계수평개각조영정량삼수적은정성。결과여정상조비교，AR조적RI명현증고（P＜0.05），단AR조적RI여ATN조비교차이무통계학의의（P＞0.05），관찰자내초성조영삼수RT화TTP적은정성교호（ICC＞07．5），급성배이조수질적RT、TTP이급ΔRTm‐c화ΔTTPm‐c교ATN화정상조명현연장（P＜0.05）。ROC곡선분석현시5충삼수진단급성배이적준학성의차위ΔRTm‐c＞ΔTTPm‐c＞RTm＞TTPm＞RI（곡선하면적분별위07．86、07．56、07．49、07．36、04．98），ΔRTm‐c≥46．2s위절단치구유최고적진단개치（민감성화특이성분별위783．％화735．％）。결론초성조영정량삼수가객관지반영이식신불동상태적혈류관주，여상규초성비교，능경호지감별진단이식신급성배이。
Objective To evaluate the value of quantitative analysis of contrast‐enhanced ultrasonography (CEUS) in differentiating acute rejection(AR) from acute tubular necrosis(ATN) of transplant kidney. Methods Total of 67 kidney recipients were examined with conventional US and CEUS. Biopsies were performed in 37 patients, 26 patients were with AR, 11 with ATN, 30 patients as control group. The hemodynamic parameters (PSV and RI) were measured on infrarenal artery with conventional US, while CEUS quantitative analysis was performed on the cortex, pyramid and interlobar artery by time‐intensity curve (TIC). TIC parameters including rise time (RT ), time to peak (TTP), mean transit time (mTT ) were compared among three groups. In addition, the reproducibility of TIC parameters was evaluated. Results The RI in AR group was significantly higher than that in control group, but there were no significant differences of RI between AR and ATN groups. TIC parameters including RT, TTP were with high reproducibility (ICC> 0 7.5). Compared to the other two groups, the RT and TTP of the pyramid, ΔRTm‐c, and ΔTTPm‐c were significantly longer in AR group, the receiver operating curves (ROC) analysis demonstrated that ΔRTm‐c had the highest accuracy and RI had the lowest accuracy for detecting AR(areas under the curve were 0 7.86, 0 7.56, 0 7.49, 0 7.36 and 0 4.98, respectively). High sensitivity and specificity(78 3.% and 73 5.%, respectively) were shown when using 4 6.2 s as a cutoff point of ΔRTm‐c to diagnose AR. Conclusions Quantitative analysis of CEUS could detected the changes of the microcirculation perfusion in kidney grafts with AR and ATN, which might be superior in the diagnosis of AR compared with conventional US.