[1]程　果,史佩佩,王晓阳,等.肾脏超声检查对慢性肾脏病的诊断价值[J].新乡医学院学报,2022,39(3):232-237.[doi:10.7683/xxyxyxb.2022.03.007]
　CHENG Guo,SHI Peipei,WANG Xiaoyang,et al.Diagnostic value of renal ultrasonography in chronic kidney disease[J].Journal of Xinxiang Medical University,2022,39(3):232-237.[doi:10.7683/xxyxyxb.2022.03.007]
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肾脏超声检查对慢性肾脏病的诊断价值
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年3
页码:
232-237
栏目:
临床研究
出版日期:
2022-03-05

文章信息/Info

Title:
Diagnostic value of renal ultrasonography in chronic kidney disease
作者:
程　果1; 史佩佩2; 王晓阳3; 贺　晓1
(1.郑州大学第一附属医院超声科，河南　郑州　450052；2.郑州大学第一附属医院小儿科，河南　郑州　450052；3.郑州大学第一附属医院肾内科，河南　郑州　450052)
Author(s):
CHENG Guo1; SHI Peipei2; WANG Xiaoyang3; HE Xiao1
(1.Department of Ultrasound,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052，Henan Province,China;2.Department of Pediatrics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan Province,China;3.Department of Nephrology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan Province,China)
关键词:
慢性肾脏病; 肾脏超声; 肾小球滤过率; 肾实质厚度; 肾脏长度
Keywords:
chronic kidney disease; renal ultrasound; glomerular filtration rate; renal parenchymal thickness; renal length
分类号:
R692.04
DOI:
10.7683/xxyxyxb.2022.03.007
文献标志码:
A
摘要:
目的　探讨肾脏超声检查对慢性肾脏病（CKD）的诊断价值。方法　选择2019年1月至2019年12月郑州大学第一附属医院收治的97例CKD患者为研究对象，依据肾脏病预后质量倡议（K/DOQI）中关于CKD的分期标准将患者分为CKD-1组（n=21）、CKD-2组（n=21）、CKD-3组（n=15）、CKD-4组（n=15）、CKD-5组（n=25）。使用彩色多普勒超声诊断仪测量患者，测量所得左右肾脏长度、肾脏宽度、肾实质厚度取其平均值得到平均肾脏长度、平均肾脏宽度和平均肾实质厚度，并分别除以身高，得到身高校正肾脏长度、身高校正肾脏宽度和身高校正肾实质厚度。使用全自动生物化学分析仪检测患者血清肌酐水平。采用经中国人改良的肾脏病膳食改良试验 (MDRD)公式计算估测肾小球滤过率（eGFR）。采用Person相关分析CKD患者肾脏超声检查指标与eGFR的相关性。绘制受试者工作特征（ROC）曲线并计算曲线下面积（AUC）评估超声检测指标对CKD 患者肾脏功能损伤的诊断效能。结果　CKD患者的血清肌酐水平随CKD分期的升高而升高，CKD患者的eGFR随CKD分期的升高而降低，各组间比较差异均有统计学意义（P<0.05）。CKD-1组与CKD-2组患者6个肾脏超声测量指标比较差异均无统计学意义（P>0.05）；CKD-3组、CKD-4组患者的身高校正肾脏长度、身高校正肾脏宽度、身高校正肾实质厚度、平均肾脏长度均显著低于CKD-1组（P<0.05）；CKD-4组患者的平均肾脏宽度显著低于CKD-1组（P<0.05）；CKD-3组、CKD-4组患者的平均肾实质厚度显著低于CKD-1组（P<0.05）；CKD-3组患者的身高校正肾脏长度、平均肾脏长度、平均肾实质厚度均显著低于CKD-2组（P<0.05）；CKD-4组患者的6个肾脏超声测量指标均显著低于CKD-2组（P<0.05）；CKD-5组患者的6个肾脏超声测量指标均显著低于CKD-1组、CKD-2组、CKD-3组、CKD-4组（P<0.05）。97例CKD患者的平均肾脏长度、平均肾实质厚度、平均肾脏宽度、身高校正肾脏长度、身高校正肾实质厚度、身高校正肾脏宽度与eGFR均呈显著正相关（r=0.66、0.72、0.40、0.70、0.75、0.43，P<0.05）。平均肾脏宽度对肾功能损伤无显著诊断价值（P>0.05）；肾脏超声测量指标与相应身高校正后的肾脏超声测量指标诊断肾脏功能损伤的AUC比较差异均无统计学意义（P>0.05）；身高校正肾脏长度联合身高校正肾实质厚度诊断慢性肾功能损伤的AUC、特异度均显著高于身高校正肾脏长度、身高校正肾脏宽度、身高校正肾实质厚度（P<0.05）。结论　身高校正肾脏长度联合身高校正肾实质厚度诊断肾脏功能损伤的AUC和特异度较高，可用于CKD 2期的早期诊断及CKD患者病程进展的评估。
Abstract:
Objective　To investigate the diagnostic value of renal ultrasound measurement indexes in chronic kidney disease (CKD).Methods　A total of 97 CKD patients admitted to the First Affiliated Hospital of Zhengzhou University from January 2019 to December 2019 were selected as the research subjects.The patients were divided into CKD-1 group(n=21),CKD-2 group (n=21),CKD-3 group (n=15),CKD-4 group (n=15),CKD-5 group (n=25) according to the staging criteria for CKD of kidney disease outcomes quality initiative (K/DOQI).Patients were measured using a color Doppler ultrasound diagnostic apparatus.The measured length,width and the thickness of the renal parenchyma of the left and right kidneys were averaged to respectively obtain the mean renal length,the mean renal width and the mean renal parenchymal thickness,and divided by the height to obtain the height-corrected renal length,height-corrected renal width and height-corrected renal parenchymal thickness.The serum creatinine levels of patients were measured by fully automated biochemical analyzer.The estimated glomerular filtration rate (eGFR) was calculated using the Chinese modification of diet in renal disease study (MDRD) formula.The correlation between renal ultrasonography and eGFR of patients with CKD was analyzed by Person correlation.The receiver operating characteristic (ROC) curve was drawn,and the area under the curve (AUC) was calculated to evaluate the diagnostic performance of ultrasound detection indicators for renal impairment in CKD patients.Results　The serum creatinine level of CKD patients increased with the increase of CKD stage,and the eGFR of CKD patients decreased with the increase of CKD stage,and the differences among groups were statistically significant (P<0.05).There was no significant difference in the six renal ultrasound measurement indexes of patients between the CKD-1 group and the CKD-2 group (P>0.05);the height-corrected renal length,height-corrected renal width,height-corrected renal parenchyma thickness and mean renal length of patients in the CKD-3 group and the CKD-4 group were significantly lower than those in the CKD-1 group (P<0.05);the mean renal width of patients in the CKD-4 group was significantly lower than that in the CKD-1 group (P<0.05);the mean renal parenchyma thickness of patients in the CKD-3 and CKD-4 groups was significantly lower than that in the CKD-1 group (P<0.05);the height-corrected renal length,mean renal length and mean renal parenchymal thickness of patients in the CKD-3 group were significantly lower than those in the CKD-2 group (P<0.05);the six renal ultrasound measurement indexes of patients in the CKD-4 group were significantly lower than those in the CKD-2 group (P<0.05);the six renal ultrasound measurement indexes of patients in the CKD-5 group were significantly lower than those in the CKD-1 group,CKD-2 group,CKD-3 group and CKD-4 group (P<0.05).The mean renal length,mean renal parenchymal thickness,mean renal width,height-corrected renal length,height-corrected renal parenchymal thickness and height-corrected renal width of the 97 CKD patients were significantly positively correlated with eGFR (r=0.66,0.72,0.40,0.70,0.75,0.43;P<0.05).The mean renal width had no significant diagnostic value for renal function damage (P>0.05);there was no significant difference in the AUC between the renal ultrasound measurement indexes and the corresponding height-corrected renal ultrasound measurement indexes in the diagnosis of renal injury(P>0.05);the AUC,specificity of the height-corrected renal length combined with the height-corrected renal parenchymal thickness in the diagnosis of chronic renal injury were significantly higher than those of height-corrected renal length，height-corrected renal width and height-corrected renal parenchymal thickness (P<0.05).Conclusion　The height-corrected renal length combined with the height-corrected renal parenchymal thickness has a higher AUC and specificity in diagnosing renal impairment,and can be used for early diagnosis of patients with CKD 2 stage and to assess the progression of CKD patients.

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更新日期/Last Update: 2022-03-05