超声血流动力学参数与实时剪切波弹性成像定量参数对肾移植后急性肾损伤的预测价值

Evaluation of ultrasound hemodynamic parameters and real-time shear wave elastography quantitative parameters for acute renal injury after renal transplantation

摘要:

目的 探究超声血流动力学参数与实时剪切波弹性成像定量参数对肾移植后急性肾损伤的预测价值。方法 选取2019年1月—2022年1月在海南医学院第二附属医院57例接受肾移植治疗的肾衰竭患者。采用彩色多普勒超声检测肾椎体叶间动脉、肾段动脉、肾主动脉的相关血流参数（搏动指数、阻力指数和峰值流速）；采用实时剪切波弹性成像检查肾皮质、髓质、肾窦的弹性模量。术后随访6个月，根据患者是否发生急性肾损伤分为急性肾损伤组和非急性肾损伤组。采用多因素Logistic逐步回归模型分析肾移植后急性肾损伤的危险因素；绘制受试者工作特征（ROC）曲线评估超声血流动力学参数与实时剪切波弹性成像定量参数对肾移植后急性肾损伤的预测效能。结果 57例接受肾移植治疗的肾衰竭患者术后发生急性肾损伤14例，发生率为24.56%。急性肾损伤组肾长径短于非急性肾损伤组（P <0.05）。急性肾损伤组肾椎体叶间动脉的搏动指数、阻力指数、肾皮质弹性模量均高于非急性肾损伤组（P <0.05）。多因素Logistic逐步回归分析结果显示，肾椎体叶间动脉搏动指数增加［O^R =3.522（95% CI：1.203，10.304）］、阻力指数增加［O^R =3.294（95% CI：1.125，9.637）］、肾皮质弹性模量增加［O^R =3.016（95% CI：1.031，8.825）］均是肾移植后急性肾损伤的危险因素（P <0.05），肾长径增加［O^R =3.418（95% CI：1.168，9.998）］是肾移植后急性肾损伤的保护因素（P <0.05）。ROC曲线分析结果显示，肾椎体叶间动脉搏动指数、阻力指数及肾皮质弹性模量单一及联合预测肾移植后急性肾损伤的敏感性分别为71.4%（95% CI：0.420，0.904）、60.7%（95% CI：0.326，0.836）、71.4%（95% CI：0.420，0.904）、85.7%（95% CI：0.562，0.975）；特异性分别为74.4%（95% CI：0.585，0.859）、60.5%（95% CI：0.445，0.746）、60.5%（95% CI：0.446，0.746）、72.1%（95% CI：0.561，0.842）；AUC分别为0.740（95% CI：0.575，0.905）、0.648（95% CI：0.477，0.818）、0.718（95% CI：0.573，0.862）、0.803（95% CI：0.642，0.964）。结论 超声血流动力学参数与实时剪切波弹性成像定量参数可用于预测肾移植后急性肾损伤，尤以肾椎体叶间动脉搏动指数、阻力指数及肾皮质弹性模量对肾移植后急性肾损伤的预测效能较高。

Abstract:

Objective To explore the value of ultrasound hemodynamic parameters and real-time shear wave elastography quantitative parameters in evaluating acute renal injury after renal transplantation.Methods Between January 2019 and January 2022, 57 patients with renal failure who received renal transplantation in the Second Affiliated Hospital of Hainan Medical College received color Doppler ultrasound to detect the blood flow signals (pulsation index, resistance index, and peak flow rate) of the interlobar artery, segmental artery and aorta, and to examine the modulus of elasticity values of the renal sinus, renal column, medulla, and renal cortex through real-time shear wave elastography. The patients were followed up for 6 months. They were divided into acute renal injury group and non acute renal injury group according to whether the patients had acute renal injury. To analyze the risk factors of acute renal injury after renal transplantation, and evaluate the predictive efficacy of ultrasound hemodynamic parameters and real-time shear wave elastography quantitative parameters for acute renal injury after renal transplantation.Results Among 57 patients with renal failure receiving renal transplantation, 14 had acute renal injury after operation, the incidence was 24.56%. The renal length and diameter in the acute renal injury group were shorter than those in the non acute renal injury group (P < 0.05). The pulsation index, resistance index, and elastic modulus of renal cortex in the acute renal injury group were higher than those in the non acute renal injury group (P <0.05). Multivariate results showed that the increased pulsation index [O^R =3.522 (95% CI: 1.203, 10.304) ], resistance index [O^R =3.294 (95% CI: 1.125, 9.637) ], and modulus of elasticity [O^R =3.016 (95% CI: 1.031, 8.825) ] of renal cortex were all risk factors for acute renal injury after renal transplantation (P < 0.05). The increase of renal length [O^R =3.418 (95% CI: 1.168, 9.998) ] was the protective factor of acute renal injury after renal transplantation (P < 0.05). The results of ROC analysis showed that the sensitivity of the pulsation index, resistance index, and modulus of elasticity of renal cortex in predicting acute renal injury after renal transplantation were 71.4% (95% CI: 0.420, 0.904), 60.7% (95% CI: 0.326, 0.836), 71.4% (95% CI: 0.420, 0.904), and 85.7% (95% CI: 0.562, 0.975), respectively; The specificity was 74.4% (95% CI: 0.585, 0.859), 60.5% (95% CI: 0.445, 0.746), 60.5% (95% CI: 0.446, 0.746), and 72.1% (95% CI: 0.561, 0.842), respectively; AUC were 0.740 (95% CI: 0.575, 0.905), 0.648 (95% CI: 0.477, 0.818), 0.718 (95% CI: 0.573, 0.862), and 0.803 (95% CI: 0.642, 0.964), respectively.Conclusion Ultrasound hemodynamic parameters and real-time shear wave elastography quantitative parameters can be used to predict the acute renal injury after renal transplantation, especially the pulsation index, resistance index, and elastic modulus of renal cortex of the interlobular artery are more effective in predicting the acute renal injury after renal transplantation.