摘要
目的:探讨剪切波弹性成像(SWE)技术在原发性肾病综合征(PNS)患者与健康者对比研究及联合肾损伤相关指标判定早期肾功能损害中的应用价值,为后续临床研究奠定基础。方法:分析检测经临床及病理证实40例PNS患者双肾平均弹性模量值(Emean)特征,另取40例健康者肾脏作为对照组,统计学分析两组肾脏Emean及一般临床资料的差异,并将双肾Emean与24小时尿蛋白量(24 h-UTP)和血清β2-微球蛋白量(β2-MG)作相关性分析。利用CKD-EPI肌酐公式将PNS患者分为PNS1及PNS2两组,分别比较两组肾脏Emean及肾功能相关指标的差异;用二元logistic回归筛选对PNS1和PNS2鉴别价值较高的指标,绘制ROC曲线,比较联合诊断的效能。结果:PNS组与对照组性别、年龄、身高、体重指数、肾脏长度、肾脏厚度、肾皮质厚度组间比较均无统计学意义(P>0.05)。PNS组双肾Emean高于对照组(P<0.05)。以Emean=13.72kPa为诊断PNS的最佳诊断分界点,ROC曲线下面积AUC=0.811,鉴别诊断两组的敏感度、特异度分别为:72.5%、85.0%(P<0.001),诊断效能最高。PNS组双肾Emean与24 h-UTP和β2-MG呈正相关,与血尿素氮(BUN)和血肌酐(Scr)无相关性。PNS2组双肾Emean、24 h-UTP、Scr高于PNS1组(P<0.05)。在Logistic回归方程模型下,联合诊断曲线下面积最大(AUC=0.893),鉴别诊断两组的敏感度、特异度分别为:78.6%、96.3%(P<0.001),联合诊断效能最高。结论:弹性模量值联合肾功能相关指标有利于对PNS早期肾功能损害进行分期,能无创性从生态学层面对PNS提供诊断与鉴别,并能为PNS早期肾损伤状态提供生态学依据,从而指导临床医生早期干预。
Objective:To explore the application value of shear wave elastography(SWE)in the comparative study of patients with primary nephrotic syndrome(PNS)and healthy subjects and in the determination of early renal function impairment combined with related indexes of renal injury.Methods:Detection of 40 patients with PNS were confirmed by clinical and pathological kidneys and average elastic modulus value(Emean)characteristics,another kidney as the control group,40 cases of healthy subjects statistical analysis of differences in two groups of kidney Emean and general clinical data,and will double kidney Emean and 24 hours urinary protein quantity 24 h-(UTP)and beta 2-micro serum globulin(beta 2-MG)for correlation analysis.CKD-EPI creatinine formula was used to divide PNS patients into PNS1 and PNS2 groups,and the differences of renal Emean and renal function related indexes between the two groups were compared respectively.Binary Logistic regression was used to screen the indicators with high differential value for PNS1 and PNS2.Multivariate Logistic regression analysis was performed and ROC curve was drawn to compare the diagnostic efficacy of renal Emean combined with renal function related indicators for PNS1 and PNS2 groups.Results:There was no statistical significance in gender,age,height,body mass index,renal length,renal thickness and renal cortical thickness between PNS group and control group(P>0.05).Kidney Emean in PNS group was higher than that in control group(P<0.05).Taking Emean=13.72 kPa as the optimal diagnostic cut-off point for PNS,the area under the ROC curve AUC=0.811,the sensitivity and specificity of the two groups for differential diagnosis were 72.5% and 85.0%(P<0.001),the highest diagnostic efficacy.In the PNS group,bilateral renal Emean was positively correlated with 24 h-UTP and β2-Mg,but not with blood urea nitrogen(BUN)and serum creatinine(SCR).Emean in PNS group was positively correlated with 24 H-UTP and β2-mg,but had no correlation with blood urea nitrogen(BUN)and blood creatinine(Scr).Emean,24 H-UTP and Scr in PNS2 group were higher than those in PNS1 group(P<0.05).Under the Logistic regression equation model,the area under the combined diagnosis curve was the largest(AUC=0.893).The sensitivity and specificity of the differential diagnosis were 78.6% and 96.3%(P<0.001),combined diagnosis was the most effective.Conclusion:The value of elastic modulus combined with renal function related indicators is conducive to the staging of early renal function damage in PNS,can provide non-invasive diagnosis and differentiation of PNS from the ecological level,and can provide ecological basis for the state of early renal damage in PNS,so as to guide the early intervention of clinicians.
作者
左娟
耿磊
穆春华
侯胜旗
戴丽
Zuo Juan;Geng Lei;Mu Chunhua;Hou Shengqi;Dai Li(Department of Ultrasound,The Fourth People's Hospital of Lianyungang City,Lianyungang,Jiangsu 222000;Depatment of Medical Imaging,Tha Second People's Hospital of Lianyungang City,Lianyungang,Jiangsu 222000)
出处
《现代医用影像学》
2022年第1期45-50,共6页
Modern Medical Imageology
关键词
剪切波弹性成像
原发性肾病综合征
肾功能
弹性模量值
肾损伤指标
shear wave elastography
primary nephrotic syndrome
renal function
elastic modulus value
kidney injury indicators
