彩色多普勒血流显像评价兔肾缺血再灌注损伤的可行性研究

目的:探讨彩色多普勒血流显像(CDFI)评价肾缺血再灌注损伤发生的可行性。方法:48只大白兔随机分为假手术对照(S)组、缺血再灌注(I/R)组。应用CDFI检测各级兔肾动脉的血流动力学变化,测定兔肾组织肿瘤坏死因子α(TNF-α)的平均光密度(OD)并做相关性分析。结果:与S组比较,I/R2h组无明显血流动力学改变,I/R8h、24h组分别出现SRA、IRA的RI增大和MRA、SRA、IRA的Vmax、PI、RI增大(P<0.05)。I/R8h,24h组TNF-α的OD高于S组(P<0.05)。I/R各组MRA、SRA和IRA的Vmax,PI,RI与兔肾组织TNF-α的OD变化呈正相关(P<0.05)。结论:CDFI是一种无创、及时的评价肾缺血再灌注损伤发生的可行方法。     

肾血流阻力指数与体外循环手术急性肾损害的相关性

目的 探讨肾血流阻力指数（RI）与体外循环手术（CPB）后急性肾功能损害（AKI）的相关性。方法 对因心脏疾病接受CPB的14例患者,应用CDFI检测术前、术后1、2、4、8、16、24 h时主肾动脉、肾段动脉阻力指数（RI）;同时检测尿素氮（Urea）、尿酸（UA）、肌酐（Crea）,评价肾功能;对所有数据进行统计学分析。结果 与术前相比,术后1、2、8、16 h主肾动脉RI、肾段动脉RI均明显增高（P均<0.05）。术前及术后各时间点主肾动脉RI与Urea、UA、Crea均呈正相关（r=0.390,0.355,0.426,P均<0.05）;肾段动脉RI与Crea呈正相关（r=0.316,P<0.05）。结论 主肾动脉、肾段动脉RI可作为评估CPB术后发生AKI的指标。     

肾脏不同类型恶性病变18F-FDG标准摄取最大值的比较

目的 探讨¹⁸F-FDG PET/CT检查标准摄取最大值(SUV_max)用以鉴别不同病理类型肾脏恶性病变的价值。方法 回顾性分析28例经手术以及组织活检病理证实的肾脏恶性病变患者资料,术前均接受PET/CT检查,采集图像并取得¹⁸F-FDG的SUV_max,采用方差分析及LSD法进行统计学分析。结果 28例中,肾透明细胞癌12例、SUV_max 2.33±1.03,非透明细胞癌8例、SUV_max 8.05±1.58,肺癌肾转移8例、SUV_max 12.87±2.93,三者间SUV_max的差异有统计学意义(F=81.031,P<0.001)。进一步两两比较,任意两者SUV_max差异均有统计学意义(P均<0.001)。结论 ¹⁸F-FDG的SUV_max定量分析对于不同病理类型肾脏恶性病变的鉴别具有一定的价值。     

彩色多普勒超声检测移植肾动脉血流阻力指数预测远期预后

目的 应用彩色多普勒超声检测早期移植肾段动脉血流阻力指数(RI),并探讨其对远期预后的影响。方法 对299例肾移植术后患者资料进行回顾,门诊随访至少3个月。根据RI将入选病例分为A组(RI≥0.8)、B组(RI<0.8)。结果 与B组相比较,A组病例在接受肾移植手术时的年龄和供肾者年龄更大(P<0.001),术前存在更严重蛋白尿(P=0.01)。移植肾RI与供肾者年龄、受肾者年龄及24 h尿蛋白量之间存在相关关系(P均<0.05)。RI是较其他因素更为可靠的预测指标。结论 彩色多普勒超声检测早期移植肾动脉血流RI可对其远期移植肾存活进行预测。     

儿童肾动脉多普勒超声正常参考值及其临床意义

目的 探讨多普勒超声测量正常儿童肾动脉血流参数的正常参考值及其临床意义。方法 随机选取319名1天~16岁正常儿童,男192名,女127名,以多普勒超声测量双侧肾脏的肾动脉血流参数,包括收缩期峰值流速(V_s)、舒张末期峰值流速(V_d)、平均血流速度(V_m)、收缩期峰值流速与舒张末期峰值流速比值(S/D)、搏动指数(PI)、阻力指数(RI)和收缩期血流加速时间(AT);分析各参数随年龄、体表面积(BSA)的变化趋势。结果 男性与女性儿童及左侧与右侧肾动脉各项血流参数差异均无统计学意义(P均>0.05);正常儿童BSA与年龄呈正相关(r=0.96,P<0.01),与肾动脉血流速度及RI分别呈正相关与负相关(P均<0.05);除AT外,肾动脉血流速度和RI以肾主动脉、段动脉、叶间动脉依次递减(P<0.05)。结论 正常儿童肾动脉多普勒超声血流参数与BSA相关,可作为儿童肾脏疾病诊断的正常参考值。     

动态增强MRI诊断前列腺中央腺体癌和不同类型前列腺增生

目的 探讨3.0T LAVA多期动态增强扫描对前列腺中央腺体癌(CGPCa)和不同类型前列腺增生(BPH)的诊断价值。方法 回顾性分析经病理证实的34例CGPCa(CGPCa组)和70例BPH(BPH组)患者的MRI、动态增强MRI(DCE-MRI)资料,分析T2WI和动态增强表现,将信号强度-时间(SI-T)曲线分为速升下降型、速升平台型、缓升平台型和持续缓升型,并对前3种曲线计算达峰时间(T_max)、最大强化程度(SI_max)和最快强化率(R_max),比较两组患者SI-T曲线类型及T_max、SI_max、R_max的差异。结果 CGPCa组SI-T曲线以速升下降型和速升平台型为主;BPH组中基质增生为主型(sBPH)SI-T曲线类型与CGPCa类似;腺体增生为主型(gBPH)以持续缓升型多见;混合型增生(mBPH)四种曲线均可见,但以持续缓升型最多。CGPCa组、sBPH亚组、mBPH亚组、gBPH亚组间SI-T曲线类型的差异有统计学意义(P<0.01),但CGPCa组与sBPH亚组的差异无统计学意义(P>0.05),CGPCa组与gBPH亚组、mBPH亚组的差异均有统计学意义(P均<0.01)。CGPCa组、sBPH亚组和mBPH亚组间T_max、SI_max、R_max的差异均有统计学意义(P均<0.05),但CGPCa组和sBPH亚组间T_max、SI_max、R_max存在较明显的重叠。结论 3.0T LAVA多期动态增强扫描SI-T曲线有助于CGPCa与gBPH、mBPH的鉴别诊断。T_max、SI_max、R_max对CGPCa和sBPH、mBPH具有一定鉴别诊断价值。     

治疗前18F-FDG PET/CT最大标准摄取值评估鼻腔NK/T细胞淋巴瘤的预后

目的 探讨¹⁸F-FDG PET/CT最大标准摄取值(SUV_max)评估治疗前鼻腔NK/T细胞淋巴瘤患者预后的价值。方法 31例确诊的鼻腔NK/T细胞淋巴瘤患者均于治疗前接受¹⁸F-FDG PET/CT检查,患者预后单因素分析采用Kaplan-Meier法,采用Cox模型进行多因素分析。结果 31例鼻腔NK/T细胞淋巴瘤患者治疗前¹⁸F-FDG PET/CT显像中位SUV_max为12.7(4.4~25.7)。单因素分析结果显示,B症状、KPI、治疗模式、SUV_max与鼻腔NK/T 细胞淋巴瘤患者的预后相关(P均<0.05);多因素分析显示仅有SUV_max是影响患者预后的独立危险因素(P=0.018)。结论 鼻腔NK/T细胞淋巴瘤患者治疗前¹⁸F-FDG PET/CT的SUV_max能够预测患者的预后。     

声触诊组织量化技术诊断甲状腺乳头状癌

目的 探讨声触诊组织量化(VTQ)技术诊断和鉴别诊断甲状腺乳头状癌的价值。方法 用常规超声及VTQ对26例甲状腺乳头状癌及33例甲状腺腺瘤患者进行检查,观察甲状腺乳头状癌的VTQ特征,绘制ROC曲线寻找判断指标,并与术后病理结果对比。结果 VTQ测得甲状腺乳头状癌患者的癌内最大(V_max)、最小(V_min)及平均剪切波速度(V_m)均明显高于甲状腺腺瘤患者(P均<0.01)。比较ROC曲线下面积,发现V_max、V_min及V_m的诊断价值明显高于簇状钙化斑。结论 VTQ技术对诊断和鉴别诊断甲状腺乳头状癌有较大价值。     

Glut1与Ki-67在结直肠癌中的表达及其与18F-FDG PET/CT SUVmax的相关性

目的 探讨葡萄糖转运蛋白1(Glut1)与细胞增殖抗原标记物Ki-67在结直肠癌(CRC)中的表达及其与¹⁸F-FDG PET/CT显像最大标准摄取值(SUV_max)的关系。 方法 对33例经术后病理证实的CRC患者术前进行全身PET/CT检查,记录病灶的SUV_max,用免疫组化方法分析Glut1、Ki-67表达,并与SUV_max进行对比分析。 结果 Glut1和Ki-67在CRC中的表达均高于正常组织(t=－4.22、－3.04,P均<0.05)。Glut1在CRC中的阳性表达率显著高于正常组织(χ²=18.94,P<0.05),在低分化CRC中的阳性表达率(5/7,71.42%)高于中-低分化(1/3,33.33%)和中分化(16/23,69.57%)CRC。CRC的 SUV_max与Glut1的表达存在相关性(r=0.63,P<0.05),与Ki-67无相关性(r=0.24,P=0.36)。不同分化程度CRC的SUV_max之间差异无统计学意义(F=0.54,P=0.59);不同肉眼大体分型CRC的 SUV_max之间差异无统计学意义(t=－0.07, P=0.95)。 结论 Ki-67可反映CRC细胞的增殖状态;CRC的SUV_max可反映CRC组织中Glut1的表达水平。     

320排CT灌注成像评价兔下肢缺血再灌注损伤

目的 观察兔下肢急性缺血再灌注损伤CT灌注成像（CTPI）参数的演变规律及与血清酶学检测指标（CK、LDH、MDA、SOD）的相关性。方法 将30只新西兰大白兔随机分为缺血再灌注（I/R）组与假手术组。将I/R组分为再灌注即刻、6、12、24 h亚组,每组6只,分别在右下肢缺血3 h后再灌注即刻、6 h、12 h、24 h时间点行双下肢CTPI并采血,得到CT灌注值血流量（AF）、血容量（BV）、对比剂清除率（C）,计算右下肢与左下肢各参数的比值,即rAF、rBV、rC,并测定血清CK、LDH、MDA、SOD;最后分别对rAF、rBV、rC与生化指标进行相关性分析。 结果 与假手术组比较,I/R组再灌注即刻、6、12、24 h亚组的rAF均值分别为0.92±0.14、0.89±0.12、0.88±0.20、0.75±0.11,随再灌注时间延长逐渐降低（P<0.05）;I/R各亚组血清CK、LDH及MDA显著高于假手术组（P均<0.05）,而SOD随再灌注时间延长而逐渐降低（P<0.05）。rAF与LDH、CK、MDA、SOD的相关系数分别为-0.64、-0.47、-0.68、0.59（P均<0.05）,仅rBV与LDH存在相关性（r=-0.45,P<0.05）。结论 320排CTPI可无创、半定量、较准确地监测兔下肢骨骼肌随再灌注时间推移的微循环改变;rAF较rBV、rC能更好地反映肌肉组织再灌注后损伤情况。     

Relevance of HLA gene polymorphisms in Romanian patients with chronic renal insufficiency undergoing renal transplantation

BackgroundChronic renal insufficiency (CRI) is a global public health problem with a high incidence in the Romanian population. In this study, we aimed to investigate genomic HLA polymorphisms in Romanian patients with CRI waiting for kidney transplantation. To determine the existence of a potential strong link between certain HLA polymorphisms and CRI, we also looked at HLA specificity combinations within the same locus or even different loci, referring to randomly inherited allelic combinations rather than potential haplotypes.MethodsA total of 2199 patients with CRI on the kidney transplantation waiting list were included. A total of 2786 healthy individuals were included as controls. Both patients and controls were assessed for both HLA I and class II genes. HLA genes were typed using the low‐resolution method polymerase chain reaction sequence‐specific primer.ResultsCertain class I and class II HLA allele groups, genotypes and haplotypes were significantly more frequent in patients with CRI than in the control individuals (eg B* 40 (p ≤ .001, pc ≤ .001), C* 12 (p ≤ .001, pc ≤ .001), DRB1*14 (p = .0022, pc = .04), C*12,‐ (p < .001, pc < .001), A*01‐C*15 (p = .0003, pc = .03) and A*02‐C*12 (p = .0005, pc = .0486)).ConclusionsHLA gene polymorphisms could be clinically relevant CRI‐associated genetic profiles in Romanian patients with CRI.     

硬皮病肾危象5例并文献复习

目的：分析硬皮病肾危象的临床特点,探讨早期诊治的重要性。方法搜集收治的5例硬皮病肾危象(SRC)患者的临床表现、实验室指标,治疗转归,总结疾病的特点并文献复习。结果本组例1患者,通过很好的控制血压及长期血液透析治疗,病情稳定。例2患者,开始诊断为“皮肌炎”,后病情转化并恶化为硬皮病肾危象,经抢救无效而死亡。例3患者,血压控制不佳,发展至尿毒症期且合并肺间质病变,经抢救无效而死亡。例4患者及时发现高血压及肾功能不全,积极使用血管紧张素转化酶抑制剂(ACEI),肾功能恢复良好。例5患者合并多器官损害,入院后抢救无效而死亡。结论硬皮病必须关注尿常规、血压及肾功能,一旦出现肾危象,需及时使用 ACEI,合并多脏器损害者,预后差。结缔组织病容易转化及误诊,进一步检查如皮肤活检及肾活检等是必要的。     

Continuous renal replacement therapy is associated with less chronic renal failure than intermittent haemodialysis after acute renal failure

Objective Acute renal failure can be treated with continuous renal replacement therapy (CRRT) or intermittent haemodialysis (IHD). Whether this choice affects renal recovery has been debated, since it has implications on quality of life and costs. Our objective was to determine the impact of CRRT and IHD on renal recovery. Design Nationwide retrospective cohort study between the years 1995 and 2004. Follow-up ranged between 3 months and 10 years. Setting Thirty-two Swedish intensive care units. Patients and participants Eligible subjects were adults treated in Swedish general intensive care units with RRT. A total of 2,642 patients from 32 ICUs were included. We then excluded patients with end-stage renal disease (252) and patients lacking a diagnosis in the in-patient register (188). Thus, 2,202 patients were studied. Follow-up was complete. Interventions None. Measurements and results The primary outcome was renal recovery. Secondarily we studied the mortality of the cohort. There were no differences between IHD and CRRT patients regarding baseline characteristics, such as age, sex and comorbidities. Of the 1,102 patients surviving 90 days after inclusion in the cohort, 944 (85.7%) were treated with CRRT and 158 (14.3%) were treated with IHD. Seventy-eight patients (8.3%; confidence interval, CI, 6.6–10.2), never recovered their renal function in the CRRT group. The proportion was significantly higher among IHD patients, where 26 subjects or 16.5% (CI 11.0–23.2) developed need for chronic dialysis. Conclusions The use of CRRT is associated with better renal recovery than IHD, but mortality does not differ between the groups. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

兔慢性肾衰竭肾血流灌注的超声造影研究

目的 应用超声造影定量评价兔慢性肾衰竭不同阶段肾皮质血流灌注的变化.方法 15只家兔注射阳离子化牛血清白蛋白(C-BSA)共8周.建立慢性肾衰竭模型.分别于注射C-BSA前、注射后2周、4周、6周、8周化验血肌酐、尿素氮;并于各时间点超声测量肾大小,之后对兔双肾进行超声造影,应用时间强度曲线定量分析肾皮质血流灌注.结果 肾皮质血流灌注从注射C-BSA后4周起减低,表现为时间强度曲线参数中峰值强度减低(P<0.05或P<0.1),同时灌注速度和廓清速度均减低,表现为达峰时间和峰值强度减半时间延迟(P<0.05或P<0.01).曲线下面积在2周、4周、6周时与注射前比较,差异无统计学意义(P>0.05),8周时减小(P<0.05或P<0.01).血肌酐、尿素氮自6周起明显升高(P<0.05或P<0.01).肾体积从2周到6周增大,皮质增厚(P<0.05或P<0.01),8周时肾体积减小(P<0.05),上述变化与病理表现相吻合.结论 超声造影结合时间一强度曲线可定量分析慢性肾衰竭不同阶段肾皮质血流灌注情况;肾血流灌注的下降早于常规实验室检查指标的异常;慢性肾衰竭血流动力学的变化与病理变化密切相关.     

Regional lymphadenopathies in patients with renal calculi: Analysis with ultrasound and MRI

Thirty-nine patients with renal calculi were retrospectively studied with magnetic resonance (MR) imaging and an ultrasound (US). All patients were examined as part of a research project for imaging evaluation of complications of extracorporeal shock wave lithotripsy. Twelve of the patients showed lymph node enlargement in the retroperitoneal perivascular space. Adenopathies were visualized by MR imaging but not with US: The presence of large lymph nodes was associated with urinary, renal parenchymal, or stone infection. When large lymph nodes are found in the retroperitoneal perivascular space in patients with lithiasis, urinary tract infection must be assumed as the cause of these adenopathies.     

MRI of hepatic iron deposition in patients with renal transplant

Excess hepatic iron deposition was found in five of 15 (33%) renal transplant patients undergoing magnetic resonance (MR) screening for avascular necrosis of the femoral heads. Only one of these patients had overt liver disease. The number of prior blood transfusions was a significant factor for this deposition, whereas the age and sex of the patients, number and type of transplants, histocompatibility alleles (HLA), and years of hemodialysis and of chronic renal failure were not significant etiological factors. Liver/fat intensity ratios of < 0.29 on T 1-weighted images and ratios of < 0.21 on T 2-weighted images and a calculated T 2 value of < 35 ms were the best indicators of iron overload.Renal transplant patients are at great risk for excess hepatic iron deposition and MR imaging is a promising tool for the diagnosis of iron overload in this patient population.     

Asymptomatic renal abscess: Evaluation with gadolinium DTPA-enhanced MRI

Incidental detection of renal mass in a transplant patient is a diagnostic challenge. These patients are at risk for the development of neoplasms and, more commonly, infection with atypical organisms. Symptomatology may be lacking in either, and both conditions may present with similar symptoms. Magnetic resonance imaging (MRI) evaluation with gadolinium DTPA is helpful in the evaluation of asymptomatic renal mass, with enhancement effectively excluding simple and hemorrhagic cysts. Because the MRI appearances of renal cell neoplasm and renal abscess overlap, both must be considered in the differential diagnosis.     

海藻酸钠微球肾动脉栓塞的动物实验研究

目的评价海藻酸钠微球栓塞剂在实验动物体内的栓塞性能、降解性和生物相容性。方法实验动物为中华小型猪8头,首先利用海藻酸钠微球全部行左肾动脉栓塞,分别于栓塞后的1、2、4、8周随机抽取其中2头实验动物行动脉造影与CT复查肾脏栓塞后变化,随后处死实验动物,对栓塞肾脏行组织学检查,同时对实验动物栓塞前后的实验室检查指标进行比较。结果栓塞后即刻动脉造影显示肾动脉阻断,1周后,肾动脉分支有再通,随着时间的延长,动脉再通越来越明显;CT复查可见被栓塞肾脏内有梗死区,肾脏逐渐变小;一直到栓塞后4周,组织学检查均可见小动脉内微球,动脉周围有炎症反应,并可见肾实质梗死灶;实验动物栓塞前后的各项实验室检查指标无显著性差异（P〉0.05）。结论海藻酸钠微球具有明确的栓塞效果,体内可降解,生物相容性良好。     

Main renal vein invasion by a transitional cell carcinoma of the renal pelvis: Documentation with CT

Invasion of the main renal vein by transitional cell cancer of the renal pelvis is an infrequently reported event. No accurate clinical frequency of this phenomenon is available. Extensive invasion of the renal parenchyma by the tumor usually is present by the time it presents in the renal vein. This article represents but the second documenting main renal vein involvement depicted with computerized tomography in a patient with carcinoma of the renal pelvis.     

误诊为肾细胞癌的少脂肪型肾脏血管平滑肌脂肪瘤的CT表现

目的 回顾性分析术前误诊为肾细胞癌(RCC)而接受手术治疗的少脂肪型肾脏血管平滑肌脂肪瘤(AML)的CT表现,以期提高对此病变的认识。 方法 5例少脂肪型AML患者(8个病灶)纳入AML组,17例肾透明细胞癌(CCRCC)作为对照1组,7例低强化RCC(LERCC,包括乳头状肾癌和嫌色细胞癌)作为对照2组,分析少脂肪型AML的CT征象,包括平扫高密度、肿瘤与肾实质交界的角征,增强扫描皮髓质期强化均匀与否。手工放置ROI并计算肿瘤的下述指标:皮髓质期瘤-皮强化比值和排泄期瘤-皮强化比值。 结果 AML组5例8个瘤体均为均匀高密度,2例CCRCC为均匀高密度,1例以高密度为主,1例乳头状肾癌为不均匀高密度,各组间差异有统计学意义(P<0.001)。AML组和对照2组均在皮髓质期均匀强化(100%),与对照1组差异有统计学意义(P=0.004)。AML组有7个,对照1组有10个,对照2组有7个瘤体为外凸型,AML组角征阳性率高于其余两组(P=0.003)。无论皮髓质期和排泄期的瘤-皮强化比值均表现为对照2组显著低于AML组和对照1组(P均<0.05),而后两者间差异无统计学意义(P=0.331、0.321)。 结论 易误诊为RCC的少脂肪型AML的可能CT表现包括:平扫高密度,外凸型者角征阳性,增强扫描均匀明显强化。如肾脏肿瘤有上述CT表现,应考虑到少脂肪型AML的可能。