肾动脉血流阻力指数在肝肾综合征早期识别中的价值

目的 探讨肾动脉血流阻力指数（resistive index，RI）在肝肾综合征（hepatorenal syndrome，HRS）早期诊断中的价值。方法以多普勒彩色超声仪检测60例肝硬化患者、21例慢性乙型肝炎患者和25例健康体检者的肾动脉血流阻力指数（RI），同时检测血肌酐（Scr）、尿肌酐（Ucr），计算24h肌酐清除率（Ccr）作为肾小球滤过率（GFR）标准，40≤Ccr〈80ml·min^-1。肝硬化者被列为亚临床HRS组。结果HRS组和亚临床HRS组RI水平明显高于单纯肝硬化组、慢性乙型肝炎组和健康对照组（P〈0．05），而亚临床HRS组与慢性乙型肝炎组及单纯肝硬化组和健康对照组Scr的差异无统计学意义。RI与Ccr呈负相关（r=-0．546，P=0．01）；受试者特征曲线（ROC）分析显示RI的曲线下面积为0．88（P=0．001）。结论RI可反映肝硬化患者的轻度肾功能损害，有助于识别亚临床肝肾综合征。

The value of renal arterial resistive index in reflecting early impairment of renal function in patients with hepatorenal syndrome

Objective To assess the value of renal arterial resistive index（RI） in reflecting early impairment of renal function in patients with subclinical hepatorenal syndrome（HRS）. Methods 60 patients with liver cirrhosis were investigated and divided into LC group （ Cer ≥ 80 ml · min ^-1, n = 44 ）, subclinical HRS group （ 40 ≤ Ccr 〈 80ml· min ^-1, n = 10 ）, and HRS group （ Cer 〈 40ml· min ^-1, n = 6）. RI, Serum creatinine （Scr） and BUN of them were assayed and compared with those of 21 patients with chronic hepatitis B （CHB） and 25 healthy persons as control group. RI was measured by Doppler Uhrasonography. Results R1 was significantly higher in subclinical HRS group and HRS group than that in LC group and control group（ P 〈 0.05 ）, while there were not significant difference in Scr and BUN between subclinical HRS group and LC group or control group. There was inverse correlation between RI and Ccr （ r = - 0. 546, P = 0. 01 ）. Receiver operating characteristics （ROC） analysis showed that the Area Under Curve was 0. 88 （ P = 0. 001 ）. Conclusions The detection of RI could demonstrate the slight renal dysfunction in cirrhotic patients, it may be a useful maker in detecting subclinical HRS in patients with liver cirrhosis.