移植肾急性排斥血流灌注与生化指标变化关系的实验研究

目的探讨超谐波声学造影(UHCI)和声学密度定量(AD)技术,定量评价异体移植肾急性排斥(AR)反应时皮质血流灌注的价值;并研究各灌注参数与血肌酐(SCr)、24h内生肌酐清除值(CCr)变化的关系。方法建立犬异体移植肾急性排斥模型,分别于术后第1、3、5、7、9、11d(T1、T3、T5、T7、T9、T11)共6个时间点,采用UHCI和AD技术检查移植肾,测定肾皮质造影后峰值密度(PI)、曲线下面积(AUC)、降支减半时间(HT)及平均通过时间(MTT)等有关灌注参数;并同时抽血查SCr、CCr,将化验结果与肾皮质灌注参数作相关性分析。结果移植肾皮质造影后各灌注参数(PI、AUC、HT、MTT)与CCr均于T5时间点发生明显变化,与T1比较差异显著(P<0.05);而SCr于T7时间点发生明显变化(P<0.05)。从T1~T11,PI、AUC、HT、MTT与SCr成不同程度的负相关,与CCr成不同程度的正相关。结论UHCI是评价移植肾AR反应时皮质血流灌注的有效方法,结合AD分析所获得的血流灌注参数可提供有关AR存在及严重性的有价值信息,对肾移植术后AR的诊断有着广泛的应用前景。

Relationship Between Biochemical Indices and Blood Perfusion of Acute Rejection in Renal Allograft:Experimental Study

Objective To explore the value of ultraharmonic contrast imaging(UHCI) and acoustic densitometry(AD) technique to quantify the cortex blood perfusion of acute rejection(AR) in renal allograft and to investigate the relationship between the serum creatinine(SCr),endogenous creatinine clearing value(CCr) and some related perfusion parameters.Methods Four canine models of acute renal allograft rejection were established.The levels of SCr and CCr were measured on the days 1,3,5,7,9,11 after transplantation(T_1,T_3,T_5,T_7,T_9,T_ 11)while UHCI and AD technique were performed to acquire some perfusion parameters in renal cortex such as the peak intensity(PI),the area under the curve(AUC),the half time of descending(HT) and the mean transit time(MTT).The values of SCr and CCr were compared with each perfusion parameter and were evaluated statistically using Pearson correlation.Results After injecting contrast agent,the PI,AUC,HT and MTT in renal cortex and CCr level changed greatly on T_5 compared to those on T_1(P<0.05);the SCr level was significantly higher on T_7 than that on T_1 (P<0.05).From T_1 to T_ 11,the PI,AUC,HT and MTT in renal cortex had a negative correlation to SCr level and had a positive correlation to CCr level.Conclusions UHCI may be an efficient technology for assessing cortex blood perfusion of the AR in renal allograft.When combined with acoustic densitometry,the perfusion parameters can provide valuable information concerning the presence and severity of AR.