肾动脉阻力指数与脾动脉阻力指数差值预测移植肾功能延迟恢复的临床价值

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ABSTRACTObjectiveTo measure renal artery resistance index（RI），and thediference betweenrenal artery RI and splenicarteryresistanceindex（△RI）byultrasound，andtoinvestigatetheclinicalvalueof△RIinpredictingdelayedgraft function（DGF）afterrenaltransplantation.MethodsAtotalof85patients withalogeneicrenal tansplantationinourhospital were selected and divided into DGF group （ n=28 ）and early graft function（IGF）group（ n =57）based on the recovery of transplantedrenalfunction.Theclinicaldataofthetwogroups werecollected，includinggender，age，donorwarm/coldischemia time，historyofhypertensio，istoryofdabetesmelitus，durationofchronickidneydisease，dialysismodeanddurationerum creatinineandestimated glomerularfiltrationrate（eGFR）atdischarge.Therenal length，renalparenchymal thickness，enal artery peak systolic velocity（PSV），renal artery RI，and splenic artery RI were measured byultrasound，and the ΔRI was calculated.The diferences inaboveparameters betweenthetwo groupswerecompared.Thecorrelations betweenultrasound parametersand clinicaldatawereanalyzed.Receiveroperating characteristic（ROC）curvewas drawn toanalyze thediagnostic eficacyof ultrasound parameters inpredicting DGFafterrenal transplantation.ResultsThedonorcold ischemia time，serum creatinineatdischarge，renalarteryRIand△RIinDGFgroup were higherthanthoseinIGFgroup，whileeGFRatdischarge was lower than that in IGF group，with statistically significant differences （all P<0.05 ）.There were no significant differences in renal length，renalparenchymalthickness，enalarteryPSVandsplenicarteryRIbetweenthetwogroups.Correlationanalysisshowed thatrenal arteryRI and△RI were positivelycorrelated with serum creatinine at discharge（r=O.230，0.25O，both P <0.05），and negatively correlated with eGFR at discharge（ r= -0.321，-0.261，both P <0.05）.There were no correlations between renal artery （20 Rl，ΔRl and donor kidneycold ischemia time.ROC curve analysis showed that the area under the curve of△RI for predicting DGFafterrenal transplantation was0.788（95%confidence interval：0.689～0.888），which was higherthanthatofrenalarteryRI [0.707 （ 95% confidence interval： 0.589～0.826）]，the diference was statistically significant （ P<0.05 ）.Conclusion Renal arteryRIand △RIcanbeusedtopredict DGFafterrenaltransplantation，with △RIdemonstratingsuperiordiagnostic eicacy.

KEYWORDS Ultrasonography；Renal artery；Splenic artery；Resistance index；Diference；Renal transplantation; Delayed graft function

同种异体肾移植术作为终末期肾病的根治性治疗手段，较透析治疗可显著改善患者生存率和生活质量1]。（剩余8083字）