增强型能量多普勒技术检测系统性红斑狼疮患者肾动脉血流动力学指数

目的 应用增强型能量多普勒（E-Flow）技术检测系统性红斑狼疮（SLE）患者肾内各级动脉血流动力学指数，评价E-Flow技术诊断SLE患者肾损害和判断预后的价值。方法 2012年5月至2013年3月哈尔滨医科大学附属第二医院收治的50例SLE患者，其中狼疮肾炎（LN）患者28例，非LN患者22例，另选择30名健康志愿者作为健康对照组。对所有入选者进行肾脏超声检查，观察肾脏的二维超声声像图并利用E-Flow技术分别测量肾脏段动脉、叶间动脉、弓状动脉、小叶间动脉的收缩期峰值流速（PSV）、舒张末期流速（EDV）以及阻力指数（RI）。采用方差分析比较健康对照组、非LN组与LN组段动脉、叶间动脉、弓状动脉、小叶间动脉PSV、EDV、RI差异，进一步组间两两比较采用LSD-t检验。采用一元线性相关分析判断LN组患者各级肾动脉的RI与血肌酐浓度的相关性。结果 非LN组患者肾脏的二维超声声像图均正常；LN组8例患者出现肾实质弥漫性改变。非LN组患者小叶间动脉的频谱与健康对照组受试者相似，舒张期充盈曲线稍减低；LN组患者小叶间动脉的频谱波峰圆钝，表现为高阻低灌注型频谱。LN组患者叶间动脉、弓状动脉、小叶间动脉的PSV均较健康对照组受试者降低，且差异均有统计学意义（t值分别为-2.46、-2.40、-3.49， P值均＜0.05或0.01）；LN组与非LN组患者各级肾动脉的EDV均较健康对照组降低，且差异均有统计学意义（LN组：t值分别为-5.50、-5.95、-5.83、-5.01，P值均＜0.01；非LN组：t值分别为-3.41、-3.69、-3.29、-2.49，P值均＜0.01或0.05）；其中LN组患者弓状动脉、小叶间动脉的PSV及EDV均较非LN组患者降低，且差异均有统计学意义（PSV：t值分别为-2.00、-2.16，P值均＜0.05；EDV：t值分别为-2.13、-2.16，P值均＜0.05）；LN组与非LN组患者各级肾动脉的RI均较健康对照组增高，且差异均有统计学意义（LN组：t值分别为12.78、13.30、11.95、9.52，P值均＜0.01；非LN组：t值分别为9.88、10.05、8.71、5.30，P值均＜0.01）；LN组患者各级肾动脉的RI均较非LN组患者增高，且差异有统计学意义（t值分别为2.05、2.38、2.43、3.57，P值均＜0.05或0.01）。同时，LN组患者各级肾动脉的RI均与血肌酐浓度呈正相关（r值分别为0.684、0.752、0.755、0.851，P值均＜0.01）。结论 E-Flow技术可清晰显示SLE患者肾动脉各级分支，并可通过测量血流动力学指数评估SLE患者的病情及预后。

Detecting the intrarenal arteries hemodynamics indexes in patients with systemic lupus erythematosus by enhance-flow

Objective To explore the reliability of assessing the renal damage and prognosis with enhance-lfow （E-Flow） in patients with systemic lupus erythematosus （SLE） by detecting hemodynamics indexes of intrarenal arteries. Methods There were 50 SLE patients who were treated in the Second Hospital Afifliated to Harbin Medical University from May 2012 to March 2013. The 50 SLE patients were divided into 2 groups：28 patients with LN and 22 ones without LN, and 30 healthy persons were served as the control group who were＆amp;nbsp;from the health check centre. All patients underwent renal ultrasonic examination, and two-dimensional images were observed. E-Flow technique were used to measure the peak systolic velocity （PSV）, end-diastolic velocity （EDV） and vascular resistance indexes （RI） of the segmental, interlobar, arcuate and interlobular arteries. ANOV was used to compare the PSV, EDV and RI of segmental, interlobar, arcuate and interlobular arteries in the three groups, and LSD-t was used to compare the indexes between the two groups. A linear correlation analysis was used to determine the correlation between the RI of the intrarenal arteries in patients with LN and the levels of serum creatinine. Results The two-dimensional images of kidneys in patients without LN were normal. There were 8 cases with renal parenchymal diffused change in patients with LN. The spectrums of interlobular arteries in patients without LN were similar with those of control subjects, and the turgor curve of diastolic phase reduced slightly. The spectrums of interlobular arteries in patients with LN were blunt, with high resistance and hypoperfusion. Compared with the control subjects, PSV of the interlobar, arcuate and interlobular arteries in patients with LN decreased statistically （t=-2.46,-2.40,-3.49, P＆lt;0.05 or 0.01）. EDV of the intrarenal arteries in patients with or without LN decreased statistically （patients with LN：t=-5.50,-5.95,-5.83,-5.01, all P〈0.01;patients without LN：t=-3.41,-3.69,-3.29,-2.49, P〈0.05 or 0.01）. Compared with patients without LN, PSV and EDV of the arcuate and interlobular arteries in patients with LN all decreased statistically （PSV：t=-2.00,-2.16, both P〈0.05;EDV：t=-2.13,-2.16, both P〈0.05）. Compared with the control subjects, RI of the intrarenal arteries in all SLE patients increased signiifcantly （patients with LN：t=12.78, 13.30, 11.95, 9.52, all P〈0.01;patients without LN：t=9.88, 10.05, 8.71, 5.30, all P〈0.01）. Compared with patients without LN, RI of the the intrarenal arteries in patients with LN increased signiifcantly （t=2.05, 2.38, 2.43, 3.57,P 〈.05 or 0.01）. There were positive correlations between the RI of the intrarenal arteries in patients with LN and the level of serum creatinine （r=0.684, 0.752, 0.755, 0.851, all P〈0.01）. Conclusions E-Flow could clearly display the branches of intrarenal arteries and assess the progress and prognosis of the patients with SLE by measuring intrarenal arteries hemodynamics.