声触诊组织定量技术在儿童紫癜性肾炎中的临床应用研究
发布时间：2019-03-15 12:24
【摘要】：目的应用声触诊组织定量(VTQ)技术检测紫癜性肾炎(HSPN)儿童、过敏性紫癜(HSP)儿童及正常健康儿童的肾皮质剪切波速度(SWV)值,比较三组SWV值的差异,并分析HSPN组肾皮质SWV值与肾脏病理改变及24小时尿蛋白定量之间的关系。探讨VTQ技术在诊断及评估儿童HSPN肾脏损伤的临床应用价值。方法收集2015年10月至2016年12月郑州大学第一附属医院小儿肾病科收治入院诊断明确并接受肾活检的46例紫癜性肾炎患儿作为HSPN组,选取尿检正常的15例初发过敏性紫癜患儿作为HSP组,选取同时期门诊体检的20例正常健康儿童作为正常对照组,并收集所有儿童的临床资料及实验室资料。所有儿童在行声触诊组织定量(VTQ)技术检测前均先行普通彩色多普勒肾脏超声检查。HSPN组患儿于VTQ技术检测后1周内在超声引导下行肾穿刺活检术,肾脏组织常规行光镜、免疫荧光及电镜检查。HSPN组患儿按肾脏病理分级分为A组(I~II级)、B组(III~IV级)2组,其中肾脏病理分级为Ⅴ级、Ⅵ级患儿均为0,并将两组的肾皮质SWV值建立受试者工作特征(Receiver operating characteristic curve,ROC)曲线;按24h尿蛋白定量分为微量或轻度蛋白尿组、中度蛋白尿组及重度蛋白尿组,然后将HSPN组患儿肾皮质SWV值与肾脏病理改变及24h尿蛋白定量进行相关性分析。结果1.HSPN组肾皮质SWV值为(2.78±0.39)m/s,HSP组肾皮质SWV值为(2.31±0.21)m/s,正常对照组肾皮质SWV值为(2.16±0.17)m/s。三组SWV值两两比较,其中HSPN组与HSP组、HSPN组与正常对照组差异有统计学意义(P0.05),HSP组与正常对照组SWV值差异无统计学意义(P0.05)。2.将HSPN组肾皮质SWV值与肾脏病理分级进行相关性分析,有统计学意义(r=0.423,P=0.003),HSPN组儿童肾皮质SWV值与肾脏病理分级呈正相关性,即测得的SWV值越大,提示肾脏病理分级越高。3.将HSPN组SWV值分别与肾小球新月体形成、肾小管-间质病变及24h尿蛋白定量进行相关性分析,均无统计学意义(P0.05)。4.将HSPN组与正常对照组的肾皮质SWV值进行比较并建立ROC曲线,曲线下最大面积(AUC)为0.916,正常对照组与HSPN组肾皮质SWV值的最佳临界值为2.37m/s,其对应的敏感度为85.4%,特异度为81.2%。5.将HSPN组的A、B两组肾皮质SWV值进行比较并建立ROC曲线,曲线下最大面积(AUC)为0.791,HSPN病理分级在III级及III级以上的最佳临界值为2.60m/s,其对应的敏感度为64.9%,特异度为77.8%。结论1.VTQ技术可以快速、无创、定量地测量儿童HSPN的肾脏弹性,肾皮质SWV值与肾脏病理分级呈正相关性,SWV值越高,提示肾脏损伤越重,病理分级越高。2.与传统超声相比,VTQ技术诊断HSPN肾脏损伤的灵敏度和特异度更高。3.VTQ技术有望成为检测儿童HSPN肾脏损伤及评估损伤程度的敏感指标,并为临床诊断及治疗提供帮助。
[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，
本文编号：2440623
[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，
本文编号：2440623
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