【作者】 薛继平；

【导师】 王健；

【作者基本信息】 山西医科大学 ， 影像医学与核医学， 2008， 硕士

【摘要】 目的:以血肌酐、尿素氮、病理检查作为参照,应用实时超声造影技术结合时间-强度曲线定量评价兔慢性肾功能衰竭(CRF)不同阶段肾皮质血流灌注的变化。方法:15只健康雄性家兔,通过连续注射阳离子化牛血清白蛋白(C-BSA)共8周,建立膜性肾病发展至CRF模型。分别于注射C-BSA前、注射后2 w、4 w、6 w、8 w抽血化验血肌酐、尿素氮;并于各时间点利用二维超声测量双侧肾脏大小、皮质厚度,之后在实时造影条件下(机械指数0.088)进行超声造影观察双侧肾脏血流灌注,并储存造影动态图像,然后应用仪器内置的Wash-in/Wash-out软件对肾脏皮质血流灌注进行定量分析,量化参数包括造影剂开始增强时间、达峰时间、峰值强度、曲线下面积以及峰值强度减半时间。每次造影结束后随机处死一只兔子,取出肾脏进行病理检查。以血生化及病理结果作为参照,比较不同阶段肾皮质的血流灌注及时间强度曲线量化参数的变化情况。结果:血生化指标肌酐、尿素氮自6 w起升高,与注射C-BSA前比较有统计学意义。二维超声结果显示肾脏从2 w到6 w体积增大,皮质增厚,此时病理出现肾小囊腔扩大、肾小球细胞肿胀、炎性细胞浸润和囊腔内渗出物。8 w时肾脏出现减小的趋势,病理出现肾小球硬化、间质纤维化和肾小管萎缩。注射C-BSA后从4 w起肾皮质血流灌注减低,表现为时间-强度曲线参数中峰值强度减低。自4 w起皮质灌注速度和廓清速度均减低,表现为达峰时间和峰值强度减半时间延迟。曲线下面积在2 w、4 w、6 w时与注射前比较,差异无统计学意义,8 w时减小。结论:超声造影结合时间-强度曲线可定量分析慢性肾功能衰竭不同阶段肾皮质血流灌注情况。肾血流灌注的下降早于常规实验室检查指标的异常。血流动力学的变化与病理变化密切相关。更多还原

【Abstract】 Objective: To access the renal perfusion of chronic renal failure (CRF) at different stages in rabbits by contrast-enhanced ultrasound with time-intensity curve, compared with the pathological changes and serum creatinine (Scr), blood urea nitrogen (BUN).Methods: Fifteen rabbit CRF models were established by intravenously injecting cationic bovine serum albumin (C-BSA) for 8 weeks. Scr and BUN were examined at pre-injection and 2w, 4w, 6w, 8w post-injection. Renal size was measured by 2D ultrasound at the same time points, and then contrast-enhanced ultrasound was performed on bilateral kidney. Renal perfusion was analyzed quantitatively with the time-intensity curve by Wash-in/Wash-out software. The parameters of the time intensity curve include time to enhancement (ET), time to peak intensity (PIT), peak signal intensity (PSI), area under the curve (AUC) and time to half of peak intensity (HPT). After that one rabbit was sacrificed randomly at each time point and its kidney was sampled for pathological examination. Investigate the changes of blood perfusion and time-intensity curve parameters in CRF rabbits at different stages with reference to the pathology and blood biochemistry.Results: The level of Scr and BUN has increased since 6w after injection of C-BSA. 2D ultrasound showed the renal volume was enlarged and the cortex was thickened from 2w to 6w post-injection; the pathological examination exhibited glomerular cyst cavity expanding, glomerular cell swelling, and inflammatory cell infiltration and exudate. At 8w post-injection, the renal size had a decreasing trend and pathological studies showed glomerular sclerosis, renal interstitial fibrosis and tubular atrophy. Renal cortical perfusion reduced from 4w, manifested as the PSI of the time-intensity curve parameters decreased. The speed of infusion and clearance was slower, shown as PIT and HPT delayed. Compared with pre-injection, there was no difference in AUC at 2w, 4w and 6w post-injection, and then AUC decreased at 8w post-injection.Conclusions: Contrast-enhanced ultrasound combined with time-intensity curve can analyze renal perfusion of CRF quantitatively at different stages. The reduction of renal perfusion was earlier than the changes of routine laboratory indexes in CRF. The change of haemodynamic was closely related with pathology.更多还原