实用器官移植电子杂志

实用器官移植电子杂志 ›› 2021, Vol. 9 ›› Issue (5): 364-371.DOI: 10.3969/j.issn.2095-5332.2021.05.006

• 论著 • 上一篇    下一篇

CEUS 对早期移植肾功能延迟恢复预测价值的临床研究

刘洪 1 ， 刘东亮 1 ，周果 2 ，陈琴 2 ，彭志飞 3 ，文婧妤 3 ，钟山 3 ，王筱啸 3 ，狄文佳 3 ，熊玮 3， 冉清 3 ，杨洪吉 3   

  1. 1. 三六三医院泌尿外科，四川 成都 610072；

    2. 四川省医学科学院·四 川省人民医院超声医学中心，四川 成都 610072 ；

    3. 四川省医学科学院·四川省人民医院器官移植中心泌尿病区，四川 成都 610072

  • 出版日期:2021-09-20 发布日期:2021-11-24
  • 基金资助:

    四川省卫生和计划生育委员会 2017 年医学科研课题项目（2017PJ156） 

The clinical study of CEUS in predicting DGF of early renal transplantation function

Liu Hong 1，Liu Dongliang 1，Zhou Guo 2，Chen Qin 2，Peng Zhifei 3，Wen Jingyu 3，Zhong Shan 3，Wang Xiaoxiao 3， Di Wenjia 3，Xiong Wei 3，Ran Qing 3，Yang Hongji 3.    

  1. 1. Department of Urology，363 Hospital（Chengdu Medical Key Specialty），Chengdu 610041，Si Chuan，China ；

    2. Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital Ultrasound Medicine Center，Chengdu 610072，

    Si Chuan，China ；

    3. Sichuan Provincial Academy of Medical Sciences & Sichuan Provincial People’s Hospital Organ Transplant Central Urinary Ward，Chengdu 610072，Si Chuan，China

  • Online:2021-09-20 Published:2021-11-24

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摘要：

目的 初步探讨在心死亡捐献供肾（donation after cardiac death，DCD）和亲属捐献供肾 （living donor kidney，LDK）移植术患者行超声、彩色超声多普勒及移植肾超声造影（contrast-enhancedultrasonography，CEUS）检查结果的特征及预测价值。方法选取 2017 年12月-2020 年6月于四川省医学科学院·四川省人民医院器官移植中心行同种异体肾移植术患者，收集发生 DGF 组患者和移植肾功能恢 复正常组（immediate graft function，IGF）的移植肾动脉阻力指数、皮质时间差、皮椎时间差、锥体峰值时间、皮质峰值强度和冷缺血时间等对肾移植术后早期发生 DGF 的预测的可行性。结果 在本次观察性研究期间，共有 60 例同种异体肾移植患者满足观察性研究纳入标准，其中术后发生 DGF 的患者共 21 例。联合移植肾主肾动脉阻力指数、移植肾皮质时间差、移植肾锥体峰值时间、移植肾皮质造影峰值强度、皮质锥体到达时间差和冷缺血时间 6 个指标，经过 logistic 回归得“复合指标值”计算式为（3.471× 主肾动脉阻力指数 + 0.157× 皮质时间差 T1 + 0.120× 皮锥时间差 - 0.105× 皮质峰值强度 + 0.005× 锥体峰值时间 + 0.550× 冷缺血时间）。“复合指标值”ROC 曲线下面积为 0.901（P ＜ 0.001），“复合指标值”诊断 95% 可信区间分别为（0.822，0.978），“复合指标值”的诊断临界值为 8.8158，灵敏度为 85.70%，特异度为 84.62%，阳性预测值为 72%，阴性预测值为 91.42%，阳性似然比为 4.77，阴性似然比 0.174。此外，本研究发现早期 1 例移植肾周巨大血肿，1 例移植肾动脉狭窄，2 例移植肾排斥。结论 本研究发现联合移植肾主肾动脉动力指数、移植肾皮质时间差、移植肾皮质造影峰值强度、移植肾皮质锥体造影达到时间差、移植肾冷缺血时间联合可早期及时预测发现移植肾功能恢复延迟，有较高的灵敏度和特异度。本次研究还发现 CEUS 对发现移植肾早期并发症有较大诊断价值，可及时发现移植肾周血肿、移植肾动脉狭窄、移植肾急性排斥等。

关键词:

超声造影 ； 移植肾功能延迟恢复 ； 肾皮质 ； 肾移植 ；心脏死亡供体 ；移植肾功能 , 延迟恢复 ； 受试者工作曲线

Abstract:

Objective To investigate the characteristics and predictive value of ultrasound（US），color doppler flow imaging（CDFI）and contrast-enhanced ultrasonography（CEUS）examinations in recipients with donationafter cardiac death（DCD）donor kidney and living donor kidney（LDK）transplantation. Methods Allogeneickidney transplantation was performed in Organ Transplantation Center of Sichuan Provincial Academy of Medical Sciences and Sichuan Provincial People's Hospital from December 2017 to January 2020. Twenty one recipients were enrolled in the DGF group，and 39 recipients with clinically confirmed normal renal function were selected as the immediate graft function group. Recipients underwent renal grayscale ultrasound，color doppler and contrast-enhanced ultrasound on the first day after renal transplantation. In the DGF group and the transplanted kidney function recovery group（IGF），the renal artery resistance index，cortical time difference，vertebral body time difference，cone peak time，cortical peak intensity and cold ischemia time were recorded to evaluate thefeasibility of these values in predicting early DGF after renal transplantation. Results In this observationalstudy，a total of 60 allogeneic kidney transplant recipients met the criteria for inclusion. Among them，21 patients developed DGF after operation. The renal artery resistance index RI，the time of transplanted renal cortex，the peak time of transplanted kidney cone，the peak intensity of transplanted renal cortex，the difference of cortical cone arrival time and cold ischemia time were combined and analyzed by logistic regression. The index value is calculated as（3.471×main renal artery resistance index +0.157×cortical time difference T1 + 0.120×cone time difference - 0. 105×cortical peak intensity + 0.005×cone peak time + 0.550×cold ischemia time）. The area under the ROC curve of the composite index value was 0.901（P ＜ 0.001），the 95% confidence interval for the composite index value was（0.822，0.978），and the diagnostic threshold for the composite index value was 8.8158，and the sensitivity was 85.70. %，the specificity was 84.62%，the positive predictive value was 72%，the negative predictive value was 91.42%，the positive likelihood ratio was 4.77，and the negative likelihood ratio was 0.174. In addition，a large area of perirenal hematoma was found in the early stage of the study，1 case of renal artery stenosis，and 2 cases of renal allograft rejection. Conclusion The study found that the combination of renal artery motility index，transplantation renal cortex time difference，transplantation renal cortex imaging peak intensity，transplantation renal cortex pyramidal imaging time difference，transplanted kidney cold ischemia time can be early and timely predictive markers of delayed graft dysfunction. It has high sensitivity and specificity. This study also found that CEUS has a greater diagnostic value in the detection of early complications of transplanted kidneys，and can promptly detect peri-renal hematomas，stenosis of the transplanted renal arteries，and acute rejection of the transplanted kidneys. 

Key words:

Contrast-enhanced ultrasonography , Renal cortex ,

Allogeneic kidney transplantation ,

Donation after cardiac death,

Delayed graft function, Receiver operating characteristic

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