彩色多普勒超声在肾移植后排斥反应诊断中的应用

目的 探讨彩色多普勒超声在移植肾排斥反应监测中的应用价值。方法 对68例肾移植患者采用彩色多普勒超声进行监测，观察移植肾的结构及体积、肾皮质厚度、肾动脉内径、血流灌注情况、血流动力学参数。结果术后随访最长者达4年，45例移植肾功能正常，未发生排斥反应者，其移植肾在彩色多普勒超声下表现为边界清晰，肾内结构清楚，皮、髓质界限分明，血流丰富。13例发生急性排斥反应者，彩色多普勒超声下可见移植肾明显肿大，肾实质血流信号稀少，叶间动脉呈断续闪烁状，弓形动脉几乎无血流信号。10例发生慢性排斥反应者，彩色多普勒超声下可见移植肾体积缩小，皮质变薄，肾皮质与肾髓质界限不清，肾内血管分枝稀疏，血管树不连续，弓形动脉及小叶间动脉往往不显示，为低速高阻血流。血流动力学参数显示，发生急性排斥反应者的肾动脉阻力指数及搏动指数明显增高，舒张期峰值流速减低；发生慢性排斥反应者的肾动脉内径明显缩小，收缩期峰值流速及舒张期峰值流速明显减低，血流灌注量明显减少，阻力指数及搏动指数明显升高，与肾功能正常者比较，差异均有统计学意义。结论对于肾移植患者的术后监测，彩色多普勒超声具有独特的优点，无创、便捷，其所测得的移植肾形态学数据和血流动力学参数对排斥反应的判断具有重要参考价值，可作为肾移植术后的常规峪测手段。     

彩色多普勒超声诊断早期移植肾急性排斥

目的探讨彩色多普勒超声图像数据分析在诊断早期移植肾急性排斥中的作用及临床价值.方法总结203例肾移植术后6～30d内行彩色多普勒超声检查,结合临床症状、生化检查并参照病理诊断,对二维灰阶图像、彩色血流图、血流频谱及阻力指数(RI)、搏动指数(PI)、收缩期与舒张期血流速度比(S/D)等参数进行回顾性分析.结果以彩色多普勒RI>0.78、PI>1.82、S/D>4.1为标准,结合彩色血流图及血流频谱形态,早期移植肾急性排斥正确诊断率可达85.7%.结论应用彩色多普勒超声诊断移植肾早期急性排斥并监测其功能恢复,具有快速、准确、无创等优点,可提早发现病情变化并指导治疗,提高移植肾存活率.     

彩色多普勒超声联合核素动态显像在肾移植术后的应用

目的：探讨彩色多普勒超声、核素动态显像在肾移植术后早期并发症诊断与鉴别诊断中的应用价值。方法：收集肾移植术后肾功能恢复不佳且行彩色多普勒超声和核素肾动态显像检查的患者59例,分为3组：急性排斥反应组18例,加速性排斥反应组12例、急性肾小管坏死组29例,同时收集术后肾功能恢复良好的正常组20例,分别统计上述4组彩色多普勒的阻力指数（RI）、移植肾体积、血流分布,分析彩色多普勒在鉴别诊断中的价值。计算核素肾动态显像的指标：灌注相内1min时腹主动脉放射性计数与移植肾放射性计数比值（K1min/A1min）,功能相20min时膀胱/移植肾放射性计数比值（B/K）,分析其诊断价值。结果：彩色多普勒检查指标中,当移植肾体积增大、血流减少、阻力指数升高均提示移植肾病变,以阻力指数较敏感,但特异性不高。根据核素肾动态显像指标的计算数据,K1min/A1min比值联合B/K比值在诊断排斥反应与肾小管坏死方面准确性较高,分别达到96.7%和89.7%;K1min/A1min〈4和B/K〈1提示排斥反应,K1min/A1min≥4和B/K〈1提示肾小管坏死。结论：彩色多普勒联合核素动态显像对于肾移植术后排异、急性肾小管坏死、移植肾功能延迟恢复的诊断与鉴别诊断具有很好的临床价值,二者联合应用,互补长短。     

声学造影与彩色多普勒能量图定量分析诊断移植肾急性排斥反应

目的 探讨声学造影结合彩色多普勒能量图定量分析对移植肾急性排斥反应的诊断价值。方法 运用电子微量注射泵对41例肾移植患者外周静脉匀速注入（2min内）声学造影剂半乳糖－棕榈酸2.5g，利用电子计算机彩色直方图软件测定术后正常组和急性排斥反应组移植肾横切面积与其内血流显示面积之比（BFAR），以比较两组移植肾血流灌注的定量分布情况及造影历时时间的差异。结果 造影后排斥组和正常组移植肾内血流显像均较造影前增强（P＜0．05），但排斥组BFAR的增加值为20．2％，明显低于正常组的29．8％（P＜0．05）；排斥组72．7％的病例BFAR＜70％，无一例BFAR＞90％；正常组42．1％的病例BFAR＞90％，无一例BFAR＜70％；造影前后比较，两组的BFAR重叠率从56．1％降至41．5％；两组的血流增强开始时间和峰值时间的差异无显著性（P＞0．05），而排斥组造影持续时间为534s，正常组为346s，差异有显著性（P＜0．01）。结论 声学造影结合彩色多普勒能量图定量分析为肾移植术后急性排斥反应的诊断提供了较为可靠、客观的影像学依据。     

多普勒能量图监测移植肾急性排斥

为探讨彩色多普勒能量图（ＣＤＥ）在监测移植肾急性排斥中的应用价值，对７１例移植肾作ＣＤＥ及常规彩色多普勒血流成像（ＣＤＦＩ）等检查，其中２２例经临床及病理证实发生了急性排斥（ＡＲ）。结果表明：根据ＣＤＥ可以诊断急性排斥，其灵敏度比ＣＤＦＩ高。若ＣＤＥ与ＣＤＦＩ结合，则诊断ＡＲ的准确性更进一步提高。多次ＣＤＥ检查动态观察移植肾可预测ＡＲ的转归和监测抗排斥的效果。认为ＣＤＥ检查是目前肾移植术后较实用的一种监测手段。     

彩色超声在移植肾急性排斥反应和急性肾小管坏死鉴别中的应用

目的 :探讨彩色超声检查在肾移植术后急性排斥反应和急性肾小管坏死鉴别诊断中的应用价值。方法 :回顾性分析 5 86例临床资料完整的肾移植病例术后彩色超声检查结果并结合临床症状、生化指标及病理检查结果 ,分为正常对照组、急性排斥组 (AR组 )和急性肾小管坏死组 (ATN组 )进行分析。结果 :①AR组长径、皮质厚度明显大于对照组 (P <0 .0 5 ) ,ATN组与对照组之间差异无统计学意义。②AR组尚可见到肾锥体增大、膨隆、回声减低等二维声像图变化。③以动脉血流阻力指数 (RI)≥ 0 .7为标准 ,AR组和ATN组RI值明显高于对照组 ,AR组和ATN组之间差异无统计学意义 (P >0 .0 5 )。④经有效抗排斥治疗AR组RI值平均 1周左右先于二维声像变化恢复 ,二维声像图变化平均于 4周左右恢复 ,而ATN组RI值平均在 3周左右恢复正常。结论 :彩色超声在移植肾急性排斥反应和急性肾小管坏死鉴别中具有良好的应用价值。     

丙型肝炎病毒感染对肾移植受者排斥反应及人/肾存活率的影响

目的 研究丙型肝炎病毒(HCV)感染是否影响移植肾急性和慢性排斥反应的发生率,以及受者和移植肾的存活率.方法 对1992年6月至2004年6月所行肾移植的495例受者进行了随访,其中术前HCV抗体阳性受者27例(HCV阳性组),随机抽取HCV抗体阴性受者27例作为对照组,行组间配对研究,分析HCV感染状态对肾移植受者急性和慢性排斥反应发生率以及人/肾存活率的影响.结果 HCV阳性组受者急性排斥反应的发生率显著高于对照组(19.14%和6.38%,P<0.01),HCV阳性组慢性排斥反应的发生率也明显高于对照组(23.40%和12.76%,P<0.01),对照组肾移植后1、3、5年人/肾存活率显著高于HCV阳性组,差异有统计学意义(P<0.01).结论 HCV感染可以明显增加肾移植受者急性和慢性排斥反应的发生率,降低人/肾存活率.     

前列腺素E1在肾移植中的应用

目的 探讨前列腺素E1（PGE1）对移植肾功能恢复的影响。方法 对96例肾移植受者术中及术后每天给予PGE1 90μg，与同期内83例未使用前列腺素E1的肾移植受者进行对比，比较两组术后尿量、血肌酐、内生肌酐清除率、B型超声波下移植肾血流阻力指数以及两组肾功能恢复延迟和急性排斥反应的发生率。结果 应用前列腺素E1的患者术后尿量及内生肌酐清除率均明显高于对照组，而血肌酐、血流阻力指数和肾功能恢复延迟发生率则明显低于对照组，但两组急性排斥反应发生率的差异无显著性。结论 前列腺素E1有利于肾移植术后移植肾功能的恢复，但不降低急性排斥反应发生率。     

灵长类动物预致敏后肾移植加速排斥反应模型的建立

目的 建立灵长类动物预致敏后肾移植加速排斥反应模型.方法 取血型相容的正常猕猴配对,预先将供者腹部全层皮肤移植到受者背部,使受者预致敏.2周后再将同一供者的左侧肾脏移植到受者腹腔内,间时切除受者自体双肾,术后予以环孢素A、霉酚酸酯和泼尼松治疗(致敏用药组),不用免疫抑制剂者为对照(致敏对照组),以未致敏的肾移植作为对照组.术后观察受者血肌酐变化、移植物存活时间及病理特点.结果 对照组的4只移植肾存活时间分别为9、18、8、7 d;致敏对照组的3只移植肾存活时间分别为3、3、4 d;致敏用药组的3只移植肾存活时间分别为2、3、4 d.移植皮肤于术后10 d出现排斥反应,至术后14 d被完全排斥.对照组于肾移植1周以后才发牛排斥反应,而致敏者均在肾移植后3 d左右发生较严重的排斥反应.结论 受者被供者皮肤预致敏后再行肾移植,可以加速移植物的排斥,且不能被环孢素A、霉酚酸酯及泼尼松所组成的三联免疫抑制方案逆转.     

肾移植排斥反应时血浆骨桥蛋白水平的变化及意义

目的 探讨肾移植排斥反应时血浆骨桥蛋白( OPN)水平的变化及意义.方法 对46例肾移植受者的临床资料及生物样本进行回顾性分析.根据移植肾组织学检查结果,46例受者被分为3组:移植肾功能稳定,且移植肾组织学检查未显示有排斥反应证据者16例,为非排斥组;移植肾组织学检查证实有急性细胞性排斥反应者22例,为急排组;移植肾组织学检查证实为慢性移植肾肾病(CAN)者8例,为慢排组.另以6名亲属活体供者作为对照组.于移植肾组织样本采集前抽取外周血,用人OPN酶联免疫吸附试验检测试剂盒测定血浆OPN水平,参照Banff 03标准对排斥反应进行分级.结果 对照组血浆OPN水平为(12.23±5.95)μg/L,非排斥组稍高,为(19.38±8.23)μg/L,两组间的差异无统计学意义( P＞0.05);慢排组血浆OPN水平为(27.77±12.27)μg/L,与非排斥组比较,差异无统计学意义(P＞0.05);急排组血浆OPN水平为(41.84±18.51)μg/L,与非排斥组比较,差异有统计学意义(P＜0.05),与慢排组比较,差异也有统计学意义(P＜0.05).急排组血浆OPN水平与排斥反应的级别具有正相关性(r=0.87,P＜0.05),发生Ⅰa级排斥反应和Ⅱb级排斥反应者间血浆OPN水平的差异有统计学意义(P＜0.05).结论 血浆OPN水平变化与急性排斥反应关系密切,其水平高低与排斥反应的级别呈正相关,可以作为诊断移植肾急性细胞性排斥反应、评估其严重程度的一个辅助指标.     

Careful clinical monitoring in comparison to sequential Doppler sonography for the detection of acute rejection in the early phase after renal transplantation

Abstract Acute rejection is the most frequent cause of early graft failure. There is unanimity that Doppler sonography is a helpful method for the detection of complications after kidney transplantation. In the past, the indication for renal biopsy relied mainly on clinical assessment, although this assessment has not been standardised. Therefore, we conducted this prospective study to compare the value of sequential Doppler measurements with a standardised clinical rejection score, based on renal function, weight gain, graft swelling and tenderness. Fifty‐eight patients (37 males, 21 females, mean age 46 ± 12 years) after kidney transplantation were consecutively enrolled into the study. Doppler investigations were obtained within the first 24 h after transplantation, followed by an interval of 48‐72 h. At the same time, a clinical examination was scored by a transplant physician blinded to the Doppler results. Clinical score and Doppler results, both were referred to the histological results of renal biopsy. In 24 out of 58 patients 25 acute rejections occurred. In seven patients, acute rejection was superimposed on primary graft failure. The cut‐off levels for rejection were set at RI ≥ 0.80 and PI ≥ 1.70 based on receiver‐operator curves using data from 663 Doppler examinations. Sensitivity and specificity was 72 % for RI, and 72 % and 74 % for PI, respectively. The calculation of the intraindividual increase (ΔRI ≥ 3 %, ΔPI ≥ 10 %) did not improve these values. The clinical score revealed a sensitivity and specificity of 82% and 87 %, respectively. The combined analysis of Doppler indices and clinical score showed a sensitivity of 96 % with a specificity of 66%. Careful clinical monitoring alone using a clinical score is an appropriate procedure with which to decide about renal biopsy. Our data show that Doppler sonography should be performed within the first 24 h after transplantation to evaluate graft perfusion and baseline values. Afterwards, it should be used when clinical signs of rejection occur to underline the decision for renal biopsy even in borderline cases.     

原位肝移植术后肾血流动力学研究

目的：探讨原位肝移植（OLT）受者肾的血流动力学变化及其相关因素。方法：20例因肝硬化行OLT患者，分别于术前、术后7d，30d，6个月及1年时应用彩色多普勒血流显像仪（CDFI）测定肾动脉血流阻力指数（RI）、测定血清肌酐（Cr）值，并与10例正常人进行对照。 结果：术后早期OLT受者RI与血清Cr在均升高（P<0.01）,至术后1年可逐渐恢复正常（P>0.05）。结论：原位肝移植术后肾血流动力学大都在1年内恢复正常，术前肾的异常及术中血流动力学变化可导致术后肾功能不全，但术后长期的肾功能改变则主要与环孢菌素（CsA）等的作用有关。     

Early computed colour echo Doppler imaging following renal transplantation

Thirty patients with renal allografts were monitored for 15 postoperative days by colour-coded Doppler imaging and categorized as stable, rejection, acute tubular necrosis and cyclosporine toxicity. All forms of graft dysfunction showed significantly raised resistance (P less than 0.01) and pulsatility (P less than 0.01) indices (RI and PI, respectively). It was not possible to use Doppler imaging to differentiate the cause of graft dysfunction, but stable grafts in patients with high cyclosporin levels had significantly higher RI (P less than 0.04) and PI (P less than 0.04) than similar grafts in patients with cyclosporine levels in the therapeutic range.     

Contribution of color and power Doppler sonography to the differential diagnosis of acute and chronic rejection, and tacrolimus nephrotoxicity in renal allografts

The aim of the present study was to differentiate acute rejection, chronic rejection, and tacrolimus nephrotoxicity with color and power Doppler imaging of renal transplants. One hundred examinations were obtained from 45 patients. Pulsatility and resistive indices were calculated from color Doppler images. The grade of renal vascularization was quantified using computer-assisted pixel analysis in a rectangular region-of-interest. The percentage of vessel-covered renal parenchyma (POV) was calculated using a histogram that discriminated renal vessels from renal parenchyma via power Doppler images. Furthermore, the distance from the most peripherally located vessels to the renal capsule (PVD) was measured. A reduced POV K 55 % proved to be the best discriminator when chronic rejection was suspected (sensitivity 79 %, specificity 87 %). Tacrolimus nephrotoxicity showed not only a moderate elevation of the Doppler signal but also an increased PVD L 3.9 mm and a normal POV. We conclude that the evaluation of renal vessels by power Doppler images improves diagnostic accuracy for patients with renal allografts. Received: 22 June 1998 Received after revision: 29 September 1998 Accepted: 12 October 1998     

Role of duplex imaging and fine needle aspiration cytology of renal allografts in monitoring response to anti-rejection therapy

The role of duplex imaging and fine-needle aspiration cytology (FNAC) in monitoring the response to anti-rejection therapy was investigated in 14 of the 22 rejection episodes which occurred in 30 renal allografts recipients. In 9 of these 14 episodes of rejection, with good resolution, both resistive (RI) and pulsatility (PI) indices decreased by significant proportions (p less than 0.05). The FNAC scores also fell significantly with anti-rejection therapy. In 5 other episodes of rejection where the graft continued to deteriorate there was no significant fall of RI and PI (p greater than or equal to 0.2). In a small group of patients, both FNAC and Doppler predicted rejection. In conclusion, both duplex imaging and FNAC have a role in selection and optimal modulation of drugs in the treatment of acute renal allograft rejection.     

Color Doppler findings in transplanted kidneys and remnant kidneys of donors 6 to 12 months after kidney transplantation

OBJECTIVES: Ultrasonography and color Doppler have been used extensively in the evaluation of transplanted kidney. The aim of this study was evaluation and comparison of color Doppler sonography findings in the remnant kidney of living donors and the transplanted kidney at 6 to 12 months after kidney transplantation. METHODS: In a cross-sectional study we evaluated ultrasonographic (US) and color Doppler findings in 20 kidney allograft recipient and donors. Group 1 were unrelated and related kidney donors, and group 2, allograft recipients. Color Doppler US was performed by one sonologist on the remnant kidney of the living donor and the transplanted kidney of the recipient at 6 to 12 months after kidney donation and transplantation. We recorded, kidney size (including length and anteroposterior diameter), cortical thickness, resistive index (RI), and pulsatile index (PI). Statistical analysis was performed using SPSS 13 win (t test) for comparison of the results in donors and recipients. All data are presented as mean values +/- SD with P values less than .05 considered significant. RESULTS: In group 1, mean age of kidney allograft recipients was 39.92 +/- 11.95 years with male-to-female ratio of 1/2. Mean length, width, and cortical thickness of the transplanted kidney were 120.15 +/- 11.95 mL, 53.65 +/- 7.50 mL, and 8.53 +/- 1.00 mL, respectively. Mean RI and PI were 0.60 +/- 0.08 and 1.02 +/- 0.23, respectively. Mean serum creatinine was 1.23 +/- 0.24 mg/dL. Mean duration of renal transplantation was 7.27 +/- 1.10 months. In group 2, mean age of recipients was 25.63 +/- 3.50 years with male-to-female ratio of 1/10. Mean length, anteroposterior diameter, and cortical thickness were 120.77 +/- 9.28 mL, 53.36 +/- 4.52 mL, and 9.04 +/- 1.27 mL, respectively. Mean RI and PI were 0.60 +/- 0.02 and 1.07 +/- 0.13, respectively. There was no significant difference in the length, anteroposterior diameter, cortical thickness, RI, and PI of donors and transplanted kidneys at 6 to 12 months after transplantation (P>.05). There was a significant increase in both donor and recipient kidney size at 6 to 12 months after transplantation (P<.05). CONCLUSION: It seems that renal US and Doppler parameters remain stable in the recipient and donor at least upon short-term evaluation. Long-term study with more patients is recommended.     

亲体原位部分肝移植术后血流动力学的变化

目的 探讨亲体原位部分肝移植术后血流动力学的变化。方法 应用彩色多普勒血流显像仪检查10例正常人和7例亲体原位部分肝移植术前、后的肝血流动力学改变。结果 6例肝移植术后经过正常，门静脉、肝动脉、肝静脉的血流于术后1－5个月逐渐恢复正常。1例肝移植术后出现并发症。肝动脉血流速度低于28cm/s，血流呈扑动状，同时阻力指数增至0.78，提示肝动脉血栓形成。结论 彩色多普勒血流影像在肝移植术前、后可有效监测肝血流动力学变化，可早期发现一些致命的并发症，为临床早期处理提供准确依据，对保证肝移植成功有着重要的临床意义。     

Monitoring of renal allografts by duplex ultrasound

Abstract. Deterioration of renal transplant function due to rejection is accompanied by changes in renal blood flow that can be measured by duplex ultrasound (DU). In the present study, 60 transplanted patients were followed up. A total of 233 duplex examinations, 68 percutaneous biopsies, 44 renal scintigraphies, and 6 transplant nephrectomies were performed on these patients. Diagnoses were made on the basis of clinical and histological data. Renal perfusion was calculated by means of DU. In addition, the arterial Doppler signals were quantified using a pulsatility index (PI). Mean perfusion of normal renal allografts was 0. 47 1/min. A decrease in blood flow could be found in acute vascular and chronic rejection but not in acute cellular rejection. A lack of renal perfusion due to acute vascular rejection was observed in four patients. Mean PI, used as a parameter of DU, rose significantly in all forms of rejection, which could be diagnosed with a sensitivity of 93% and a specificity of 86%. Cyclosporin overdosage did not alter the Doppler flow shape.