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。

Diagnostic value of color Doppler ultrasonography in renal allograft rejection

Objective To explore the value of color Doppler ultrasonography in the diagnosis of renal allograft rejection. Methods Sixty-eight patients with renal allografts were enrolled. Renal blood flow perfusion, pulse index (PI) and resistance index (RI) as well as the thickness of the renal cortex and kidney size were measured by color Doppler flow imaging (CDFI) and power Doppler imaging (PDI). The episode of renal allograft rejection was confirmed by renal biopsy. Results During a 4-year-follow up, 45 patients kept normal level of serum creatinine without any incidence of rejection. Renal rejection episodes appeared in 23 patients in whom renal arterial RI and PI were increased significantly as compared with those with stable renal function. In the patients with acute rejection, the long axis and the thickness of the renal cortex were increased significantly. However, the long axis, width and the thickness of the renal cortex were decreased in the patients with chronic rejection. Conclusion As noninvasive monitoring methods, CDFI and PDI were valuable for the diagnosis of allograft rejection in the patients with kidney transplantation.