【摘要】：目的應(yīng)用聲觸診組織定量(VTQ)技術(shù)檢測紫癜性腎炎(HSPN)兒童、過敏性紫癜(HSP)兒童及正常健康兒童的腎皮質(zhì)剪切波速度(SWV)值,比較三組SWV值的差異,并分析HSPN組腎皮質(zhì)SWV值與腎臟病理改變及24小時(shí)尿蛋白定量之間的關(guān)系。探討VTQ技術(shù)在診斷及評(píng)估兒童HSPN腎臟損傷的臨床應(yīng)用價(jià)值。方法收集2015年10月至2016年12月鄭州大學(xué)第一附屬醫(yī)院小兒腎病科收治入院診斷明確并接受腎活檢的46例紫癜性腎炎患兒作為HSPN組,選取尿檢正常的15例初發(fā)過敏性紫癜患兒作為HSP組,選取同時(shí)期門診體檢的20例正常健康兒童作為正常對(duì)照組,并收集所有兒童的臨床資料及實(shí)驗(yàn)室資料。所有兒童在行聲觸診組織定量(VTQ)技術(shù)檢測前均先行普通彩色多普勒腎臟超聲檢查。HSPN組患兒于VTQ技術(shù)檢測后1周內(nèi)在超聲引導(dǎo)下行腎穿刺活檢術(shù),腎臟組織常規(guī)行光鏡、免疫熒光及電鏡檢查。HSPN組患兒按腎臟病理分級(jí)分為A組(I~II級(jí))、B組(III~IV級(jí))2組,其中腎臟病理分級(jí)為Ⅴ級(jí)、Ⅵ級(jí)患兒均為0,并將兩組的腎皮質(zhì)SWV值建立受試者工作特征(Receiver operating characteristic curve,ROC)曲線;按24h尿蛋白定量分為微量或輕度蛋白尿組、中度蛋白尿組及重度蛋白尿組,然后將HSPN組患兒腎皮質(zhì)SWV值與腎臟病理改變及24h尿蛋白定量進(jìn)行相關(guān)性分析。結(jié)果1.HSPN組腎皮質(zhì)SWV值為(2.78±0.39)m/s,HSP組腎皮質(zhì)SWV值為(2.31±0.21)m/s,正常對(duì)照組腎皮質(zhì)SWV值為(2.16±0.17)m/s。三組SWV值兩兩比較,其中HSPN組與HSP組、HSPN組與正常對(duì)照組差異有統(tǒng)計(jì)學(xué)意義(P0.05),HSP組與正常對(duì)照組SWV值差異無統(tǒng)計(jì)學(xué)意義(P0.05)。2.將HSPN組腎皮質(zhì)SWV值與腎臟病理分級(jí)進(jìn)行相關(guān)性分析,有統(tǒng)計(jì)學(xué)意義(r=0.423,P=0.003),HSPN組兒童腎皮質(zhì)SWV值與腎臟病理分級(jí)呈正相關(guān)性,即測得的SWV值越大,提示腎臟病理分級(jí)越高。3.將HSPN組SWV值分別與腎小球新月體形成、腎小管-間質(zhì)病變及24h尿蛋白定量進(jìn)行相關(guān)性分析,均無統(tǒng)計(jì)學(xué)意義(P0.05)。4.將HSPN組與正常對(duì)照組的腎皮質(zhì)SWV值進(jìn)行比較并建立ROC曲線,曲線下最大面積(AUC)為0.916,正常對(duì)照組與HSPN組腎皮質(zhì)SWV值的最佳臨界值為2.37m/s,其對(duì)應(yīng)的敏感度為85.4%,特異度為81.2%。5.將HSPN組的A、B兩組腎皮質(zhì)SWV值進(jìn)行比較并建立ROC曲線,曲線下最大面積(AUC)為0.791,HSPN病理分級(jí)在III級(jí)及III級(jí)以上的最佳臨界值為2.60m/s,其對(duì)應(yīng)的敏感度為64.9%,特異度為77.8%。結(jié)論1.VTQ技術(shù)可以快速、無創(chuàng)、定量地測量兒童HSPN的腎臟彈性,腎皮質(zhì)SWV值與腎臟病理分級(jí)呈正相關(guān)性,SWV值越高,提示腎臟損傷越重,病理分級(jí)越高。2.與傳統(tǒng)超聲相比,VTQ技術(shù)診斷HSPN腎臟損傷的靈敏度和特異度更高。3.VTQ技術(shù)有望成為檢測兒童HSPN腎臟損傷及評(píng)估損傷程度的敏感指標(biāo),并為臨床診斷及治療提供幫助。
[Abstract]:Objective to detect the shear wave velocity (SWV) of renal cortex in children with Henoch-Schonlein purpura (HSP), Henoch-Schonlein purpura (HSP) and children with Henoch-Schonlein purpura (HSP) by acoustic palpation tissue quantitative (VTQ). The relationship between renal cortex SWV value and renal pathological changes and 24-hour urinary protein quantity in HSPN group was also analyzed. To evaluate the clinical value of VTQ in the diagnosis and evaluation of renal injury in children with HSPN. Methods from October 2015 to December 2016, 46 children with Henoch-Schonlein purpura nephritis admitted to the Department of Pediatric Nephropathy, the first affiliated Hospital of Zhengzhou University, were selected as HSPN group. Fifteen newly diagnosed Henoch-Schonlein purpura patients with normal urine examination were selected as HSP group, and 20 normal healthy children who were examined in the same period were selected as normal control group. The clinical and laboratory data of all children were collected. All children were examined by ordinary color Doppler ultrasound before palpation tissue quantitative (VTQ). The children in VTQ group underwent ultrasound guided renal biopsy within 1 week after the detection of HSPN technique, and the renal tissues were routinely performed under light microscope, and the renal tissues of the children in group A were examined by ultrasound guided biopsy, and the renal tissues in group A were examined by routine light microscope. Children in HspN group were divided into two groups according to renal pathological grade: group A (I~II grade), B group (III~IV grade), in which renal pathological grade was grade 鈪，

本文編號(hào)：2440623