Color Doppler Ultrasound and Hemodynamics for Evaluating Graft Dysfunction in Recurrent Immunoglobulin A Nephropathy.
Color Doppler Ultrasound and Hemodynamics for Evaluating Graft Dysfunction in Recurrent Immunoglobulin A Nephropathy.
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DOI：
10.12659/aot.931736
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发表时间：
2021-08-20
影响因子：
1.1
通讯作者：
Wang CX
中科院分区：
文献类型：
--
作者：
Zhang J;Chen GD;Qiu J;Tan Y;Liu GC;Chen LZ;Jia W;Fu W;Wang CX
本研究的目的是探讨彩色多普勒超声对复发性免疫球蛋白A肾病（IgAN）移植肾功能障碍的诊断和预后价值。我们选择了2004年7月至2019年1月活体移植后诊断为复发性IgAN的78例活检。根据Lee分类法，回顾性分析不同组织病理损伤程度的多普勒参数。术后4年移植肾累计存活率为66.3%，Lee's分级的Kaplan-Meier曲线差异有显著性（P<0.01）。多普勒参数显示，肾动脉主干（MRA）、肾段动脉（SRA）、肾叶间动脉（伊拉）回声增强，血流分布减少，舒张末期血流速度（EDV）降低，肾弓状动脉（ARA）阻力指数（RI）升高，在Lee's分级Ⅰ ~ Ⅴ级间差异有显著性（P<0.05）。Logistic多因素分析显示，SRA的回声增强（HR 13.6，95% CI 2.7-68.4）和EDV降低（HR 1.1，1 cm/s，95% CI 1.0-1.2）是严重损伤（IV-V）的独立预测因子。由SRA的回声增强和EDV降低拟合的ROC曲线的曲线下面积为0.87。截止值为17.5 cm/s（SRA的EDV降低），无回声增强。其敏感性和特异性分别为72.2%和91.7%。彩色多普勒超声成功地评估了移植物功能障碍复发IgAN;减少的SRA EDV表明严重的组织病理学损伤和预后不良。
The aim of this study was to investigate the diagnostic and prognostic utility of color Doppler ultrasound for graft dysfunction in recurrent immunoglobulin A nephropathy (IgAN). We selected a series of 78 biopsies diagnostic of recurrent IgAN following living-donor transplantation from July 2004 to January 2019. Based on Lee’s classification, Doppler parameters in different degrees of histopathological injury were retrospectively analyzed. The 4-year cumulative graft survival rate after biopsy was 66.3%, and the difference among the Kaplan-Meier curves of Lee’s classification (P<0.01) was significant. Doppler parameters showed that echo enhancement, decreasing blood flow distribution, decreasing end-diastolic velocity (EDV) of the main renal artery (MRA), segmental renal atery (SRA) and interlobar renal artery (IRA), and an elevated resistance index (RI) of the arcuate renal artery (ARA) were significantly different among grades I-V of Lee’s classification (P<0.05). Logistic multivariate analysis indicated that echo enhancement (HR 13.6, 95% CI 2.7–68.4) and decreasing EDV of the SRA (HR 1.1 for a 1-cm/s, 95% CI 1.0–1.2) were independent predictors of severe injury (IV–V). The ROC curve fitted by echo enhancement and decreasing EDV of the SRA had an area under the curve of 0.87. The cutoff was 17.5 cm/s (decreasing EDV of the SRA) without echo enhancement. The sensitivity and specificity were 72.2% and 91.7%, respectively. Color Doppler ultrasound successfully evaluated the graft dysfunction in recurrent IgAN; a decreasing EDV of the SRA indicated severe histopathological injury and poor prognosis.