A Novel Simple Noninvasive Index to Predict Renal Transplant Acute Rejection by Contrast-Enhanced Ultrasonography
A Novel Simple Noninvasive Index to Predict Renal Transplant Acute Rejection by Contrast-Enhanced Ultrasonography
复制标题
通过超声造影预测肾移植急性排斥反应的新型简单无创指数
DOI：
10.1097/tp.0000000000000382
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发表时间：
2015-03-01
期刊：
影响因子：
6.2
通讯作者：
He, Wanyuan
中科院分区：
文献类型：
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作者：
Jin, Yunjie;Yang, Cheng;He, Wanyuan
目的探讨定量超声造影(CEUS)在评估移植肾功能障碍中的应用，建立一种新的预测急性排斥反应(AR)的无创性指标。方法57例肾移植受者参加前瞻性研究。移植肾活检前行CEUS检查。活检证实AR 23例(AR组)，急性肾小管坏死10例(ATN组)，进展正常24例(稳定组)。分析超声造影参数，包括上升时间(RT)、达峰时间(TTP)和感兴趣区之间的增量时间(&DGR；RT和&DGR；TTP)。结果AR组叶间动脉和延髓的RT、TTP(RTI、RTM、TTPI和TTPM)以及延髓与皮质的&DGR；RT和&DGR；TTP(&DGR；RTM-c和&DGR；TTPM-c)显著高于稳定组。RTM和TTPM以及&DGR；RTM-c和&DGR；TTPM-c均显著高于ATN组。多因素分析显示，肾小球滤过率和肾小球滤过率是独立的预测因素(P=0.008和P=0.024)。在多变量分析结果和单个标志物受试者工作特征曲线下面积的基础上，我们构造了一个新的简单指数，P=−0.587+0.286×DGR；rTm-c−0.028×EGFR；新指数=Ep/(1+Ep)，它比EGFR值和单个CEUS参数具有更好的受试者工作特征曲线下面积。结论超声造影参数是判断移植肾血流灌注状态的可靠指标。此外，新的简单指数可以很容易地预测AR，具有很高的准确度。
Purpose This study aimed to evaluate the application of quantitative contrast-enhanced ultrasonography (CEUS) in the assessment of renal allograft dysfunction and to establish a new noninvasive index to predict acute rejection (AR). Methods Fifty-seven renal transplant recipients were enrolled in this prospective study. Before renal allograft biopsy, CEUS examinations were performed. The biopsy results proved 23 cases of AR (AR group), 10 cases of acute tubular necrosis (ATN group), and 24 with normal evolution (stable group). Contrast-enhanced ultrasonography parameters including rising time (RT), time to peak (TTP), and the delta-time among regions of interest (&Dgr;RT and &Dgr;TTP) were analyzed. Results In the AR group, RT and TTP of interlobar artery and medulla (RTi, RTm, TTPi, and TTPm) as well as &Dgr;RT and &Dgr;TTP between medulla and cortex (&Dgr;RTm-c and &Dgr;TTPm-c) were significantly higher compared with those in the stable group. RTm and TTPm as well as &Dgr;RTm-c and &Dgr;TTPm-c were remarkably higher compared with those in the ATN group. &Dgr;RTm-c and estimated glomerular filtration rate (eGFR) were identified as independent predictors by multivariate analysis (P = 0.008 and P = 0.024). On the basis of the multivariate analysis results and area under the receiver operating characteristic curves of individual markers, we constructed a new simple index, P = −0.587 + 0.286 × &Dgr;RTm-c − 0.028 × eGFR; new index = eP/(1 + eP), to discriminate AR, which had better area under the receiver operating characteristic curves than eGFR or individual CEUS parameters. Conclusion Contrast-enhanced ultrasonography parameters are reliable markers for differentiating the perfusion status of transplanted kidneys. Furthermore, the new simple index can easily predict AR with a high degree of accuracy.