移植肾急性排斥反应彩色多普勒超声诊断的临床价值

背景:应用彩色多普勒超声检查,可以直观地了解移植肾的大小、形态、结构、血流分布情况.通过血流显像技术,可以及时而准确地了解移植肾血流灌注情况,为移植肾后并发症的诊断和鉴别诊断提供帮助.目的:观察移植肾急性排斥反应的血流动力学特征,总结移植肾急性排斥反应期二维及彩色多普勒血流显像的特异性表现,以期得到超声诊断移植肾急性排斥反应的有效指标.设计、时间及地点:对比观察,于2003-01/2007-01在暨南大学和深圳大学第一医院完成.对象:纳入实施肾移植的患者299例,根据移植肾功能分成2组,肾功能稳定组236例,急性排斥反应组63例.方法:对236例移植肾功能稳定期与63例移植肾急性排斥反应期患者的主肾动脉及弓状动脉的收缩期最大峰值流速、舒张末期流速、平均流速、阻力指数、搏动指数结果进行比较分析.主要观察指标:两组移植肾动脉内径与血流动力学结果.结果:与移植肾功能稳定组相比,移植肾发生急性排斥反应时肾内血流灌注减少,达不到皮质边缘处,肾动脉血流速度舒张期明显下降,搏动指数、阻力指数明显增高(P < 0.05).结论:彩色多普勒超声作为一种简便、经济的无创性技术,移植肾锥体回声减低、舒张期肾动脉血流速度下降、肾血流阻力指数、搏动指数升高对诊断移植肾急性排斥反应有特异性,对移植肾急性排斥反应的早期诊断有较高的评估价值.

Clinical value of color Doppler ultrasound in diagnosis of acute rejection following renal transplantation

BACKGROUND: Using color Doppler ultrasonography, renal graft size, appearance, structure, and blood flow distribution can be observed. Through the use of blood flow display technique, blood flow perfusion of renal graft can be accurately observed to assist diagnosis and differential diagnosis of complications following renal transplantation. OBJECTIVE: To observe the hemodynamic characteristics during different periods of acute renal transplant rejection, summarize its specific manifestations through analyzing different reaction of two dimensional and color Doppler flow imaging (CDFI) during renal transplantation in order to get valuable index on acute rejection of renal transplantation.DESIGN, TIME AND SETTING: Comparative observation was performed at the Jinan University and First Hospital of Shenzhen University between January 2003 and January 2007.PARTICIPANTS: A total of 299 patients undergoing renal transplantation were divided into normal allograft group (n=236) and acute rejection group (n=63) according to renal allograft function.METHODS: The systolic peak flow rate, end-diastolic flow rate, mean flow rate, pulsatility index and resistance index of main renal artery and arcuate artery in patients of two groups were compared. MAIN OUTCOME MEASURES: Renal allograft arterial inner diameter and hemodynamics of two groups.RESULTS: Compared with normal allograft group, the blood flow perfusion was reduced at acute rejection, which could not reach cortex margin, blood velocity was decreased at the diastolic phase, pulsatility index and resistance index were increased (P < 0.05). CONCLUSION: Color Doppler ultrasound, as a convenient, economical and noninvasive technique, provides the reliable evidences for the renal artery pulsatility index and resistance index in clinic, and also is valuable for the acute rejection early diagnosis of renal allograft.