肾动脉阻力指数预测梗阻性肾衰肾功能可复性研究
摘要
目的：探讨超声测量的肾动脉阻力指数(RI)对于预测梗阻性肾衰患者肾功能可复性的作用。同时探讨梗阻性肾病患者肾动脉阻力指数与肾功能之间的相关性。
方法：对31名梗阻性肾衰患者在解除梗阻之前和解除梗阻后3天，2周，6周，8周分别用超声测量肾脏弓形动脉RI值，同时在各时间点抽血测其肾功能(BUN，Cr值)，另对性别年龄与研究组相匹配的16名健康志愿者的31个肾脏测量弓形动脉RI值。
将患者据病史分为急性组(病史＜2周)和慢性组(病史＞=2周)。分别分析此两组肾功能及RI值在解除梗阻前后随时间的变化趋势。据患者解除梗阻后肾功能恢复情况分为两个组：肾功能显著好转组(第一组)和肾功能无明显改善组(第二组)。分析RI值与肾功能可否恢复的关系。对各时间点测得的肾功能指标值与RI值作相关性分析。将正常对照组RI值与第一组和第二组RI值作比较。
结果：本研究结果显示：急性组RI值由解除梗阻前的0.71±0.03在解除梗阻后3天降为0.61±0.02(P＜0.01)，在解除梗阻后2周又降至0.57±0.02(P＜0.01)，此后不再有显著变化。慢性组RI值由解除梗阻前的0.77±0.06在解除梗阻后3天降为0.73±0.03(P＜0.01)，在解除梗阻后2周降至0.70±0.04(P＜0.01)，解除梗阻后6周又下降至0.67
天津医科大学硕士研究生学位论文
士0.07(P<0.01)，此后不再有显著变化。急性组BtJN和Cr由解除梗
阻前的8.03士1 .89(BIJN)，172.97士62.79(Cr)在解除梗阻后3天降
为6.04士0.82(BIJN)，1 15.43士21.49(Cr)(P<0.01)，在解除梗阻后2
周又降至4.90士0.66(BIJN)，97.50士19.64(Cr)(P<0.01)，此后不再
有显著变化。慢性组BUN和C:由解除梗阻前的13.62士5.06(BUN)，
358.32士176.48(Cr)在解除梗阻后3天降为11.49士3.21(BljN)，287.73
士1 17.12(Cr)(P<0.01)，在解除梗阻后2周降至10.14士2.48(BUN)，
244.81士93.74(Cr)(P<0.01)，解除梗阻后6周又下降至8.42士2.73
(BL)N)，192.28士96.77(Cr)(P 与肾功能之间具有较好的相关性。第一组与第二组解除梗阻之前RJ值
比较差别无显著性(P>0.05)。第一组解除梗阻前后RI值比较差别有显
著性(P<0.05)，第二组解除梗阻前后RJ值比较差别无显著性(P>.05)。
正常对照组RI为0.59士0.03，它与解除梗阻后第一组RI值比较差别无
显著性(P>0.05)，与解除梗阻后第二组比较差别有显著性(P<0.05)，
第二组比正常对照组显著增高。
结论:解除梗阻之前RI值不能预测解除梗阻后肾功能的可复性。
解除梗阻后班值从之前的较高水平显著降低可以作为肾功能恢复的早
期指标。梗阻性肾病患者班值与肾功能之间具有较好的相关性。
Objectives:To investigate the values of the renal resistive index (RI) before and at different points after relief of obstructive renal failure and to correlate these values with the corresponding values of serum urea and creatinine and with the recovery of renal function after release of obstrution.
Methods:A total of 31 consecutive patients with obstructive renal failure were evaluated by measurement of RI before drainage and at 3 days,2 weeks,6 weeks,and 8 weeks after drainage.Serum urea and creatinine were measured at all points of the RI examination.Moreover,RI was measured in an age and sex-matched control group of 16 healthy volunteers.
According to patients' medical history,obstructed kidneys were classified into two groups:acute group(medical history
方法：对31名梗阻性肾衰患者在解除梗阻之前和解除梗阻后3天，2周，6周，8周分别用超声测量肾脏弓形动脉RI值，同时在各时间点抽血测其肾功能(BUN，Cr值)，另对性别年龄与研究组相匹配的16名健康志愿者的31个肾脏测量弓形动脉RI值。
将患者据病史分为急性组(病史＜2周)和慢性组(病史＞=2周)。分别分析此两组肾功能及RI值在解除梗阻前后随时间的变化趋势。据患者解除梗阻后肾功能恢复情况分为两个组：肾功能显著好转组(第一组)和肾功能无明显改善组(第二组)。分析RI值与肾功能可否恢复的关系。对各时间点测得的肾功能指标值与RI值作相关性分析。将正常对照组RI值与第一组和第二组RI值作比较。
结果：本研究结果显示：急性组RI值由解除梗阻前的0.71±0.03在解除梗阻后3天降为0.61±0.02(P＜0.01)，在解除梗阻后2周又降至0.57±0.02(P＜0.01)，此后不再有显著变化。慢性组RI值由解除梗阻前的0.77±0.06在解除梗阻后3天降为0.73±0.03(P＜0.01)，在解除梗阻后2周降至0.70±0.04(P＜0.01)，解除梗阻后6周又下降至0.67
天津医科大学硕士研究生学位论文
士0.07(P<0.01)，此后不再有显著变化。急性组BtJN和Cr由解除梗
阻前的8.03士1 .89(BIJN)，172.97士62.79(Cr)在解除梗阻后3天降
为6.04士0.82(BIJN)，1 15.43士21.49(Cr)(P<0.01)，在解除梗阻后2
周又降至4.90士0.66(BIJN)，97.50士19.64(Cr)(P<0.01)，此后不再
有显著变化。慢性组BUN和C:由解除梗阻前的13.62士5.06(BUN)，
358.32士176.48(Cr)在解除梗阻后3天降为11.49士3.21(BljN)，287.73
士1 17.12(Cr)(P<0.01)，在解除梗阻后2周降至10.14士2.48(BUN)，
244.81士93.74(Cr)(P<0.01)，解除梗阻后6周又下降至8.42士2.73
(BL)N)，192.28士96.77(Cr)(P
比较差别无显著性(P>0.05)。第一组解除梗阻前后RI值比较差别有显
著性(P<0.05)，第二组解除梗阻前后RJ值比较差别无显著性(P>.05)。
正常对照组RI为0.59士0.03，它与解除梗阻后第一组RI值比较差别无
显著性(P>0.05)，与解除梗阻后第二组比较差别有显著性(P<0.05)，
第二组比正常对照组显著增高。
结论:解除梗阻之前RI值不能预测解除梗阻后肾功能的可复性。
解除梗阻后班值从之前的较高水平显著降低可以作为肾功能恢复的早
期指标。梗阻性肾病患者班值与肾功能之间具有较好的相关性。
Objectives:To investigate the values of the renal resistive index (RI) before and at different points after relief of obstructive renal failure and to correlate these values with the corresponding values of serum urea and creatinine and with the recovery of renal function after release of obstrution.
Methods:A total of 31 consecutive patients with obstructive renal failure were evaluated by measurement of RI before drainage and at 3 days,2 weeks,6 weeks,and 8 weeks after drainage.Serum urea and creatinine were measured at all points of the RI examination.Moreover,RI was measured in an age and sex-matched control group of 16 healthy volunteers.
According to patients' medical history,obstructed kidneys were classified into two groups:acute group(medical history
引文
1. Slobodan Ilic, et al. The predictive value of ~(131)I-Hippurate clearance in the prognosis of acute renal failure. Renal Failure. 2000,22(5): 581-589
2. Thompson A, et al. The use of renal scintigraphy in assessing the potential for recovery in the obstructed renal tract in children. BJU International. 2001,87: 853-856
3. Konda R, et al. Ultrasound grade of hydronephrosis and severity of renal cortical damage on ~(99m)Technetium dimercaptosuccinic acid renal scan in infants with unilateral hydronephrosis during followup and after pyeloplasty. J Urol. 2002,167: 2159-63
4. Gupta DK, et al. Percutaneous nephrostomy in children with ureteropelvic junction obstruction and poor renal function. Urology. 2001,57(3): 547-50
5. Hussain M, Ali B, et al. Prediction of renal function recovery in obstructive renal failure due to stones. J Pak Med Assoc. 1997, 47(6): 159-61
6. Huland H, et al. A new test to predict reversibility of hydronephrotic atrophy after stable partial unilateral ureteral obstruction. J Urol. 1988, 140: 1591-4
7. George M, et al. TGF-β mRNA expression in the renal pelvis after experimental and clinical ureteropelvic junction obstruction. J Urol.1996,156: 261-266
8. Furness PD 3rd, et al. Elevated bladder urine concentration of transforming growth factor-betal correlates with upper urinary tract obstruction in children. J Urol. 1999,162(3pt2): 1033-6
9. Palmer LS, et al. Urine levels of transforming growth factor-betal in children with ureteropelvic junction obstruction. Urology. 1997,50(5): 769-73
10. Kim WJ, et al. Collagen-to smooth muscle ratio helps prediction of prognosis after pyeloplasty. J Urol. 2000,163(4): 1271-5
11. Chevalier RL, et al. Recovery following relief of unilateral ureteral obstruction in the neonatal rat. Kidney Int. 1999,55(3): 793-807
12．钱林，柳明等．肾积水肾切除原因的探讨．重庆医学．2000，29(2)：130
13．姚启盛，王晓康等．彩色多普勒超声在肾积水肾功能可复性预测中的价值．中国超声医学杂志．1996，12(10)：5-7
14．王洁，廖贤平等．肾动脉阻力指数预测上尿路梗阻肾功能的临床价值．武警医学．1999，10(7)：394-396
15. Sholceir Ahmed A et al. Partial ureteral obstruction: Role of renal resistive index in stages of obstruction and release. Urology. 1997, 49(4):528-535
16. Shokeir AA. et al. Recoverability of renal function after relief of acute complete ureteral obstruction: clinical prospective study of the role of renal resistive index. Urology 2002,59(4): 506-510
17. Chevalier RL, et al. Recovery from release of ureteral obstruction in the rat: relationship to nephrogenesis. Kidney Int. 2002, 61(6): 2033-43
18. Aziz MH, et al. In hydronephrosis less than 10% kidney function is not an indication for nephrectomy in children. Bur J Pediatr Surg. 2002,12(5): 304-7
19. Schuster T, et al. Clinical impact of differential renal function to indicate and assess pyeloplasty and the significance of coexisting vesicoureteral reflux. Clin Nucl Med. 2001,26(11): 923-9
20. Bassiouny IE: Salvage pyeloplasty in non-visualizing hydronephrotic kidney secondary to ureteropelvic junction obstruction. J Urol. 1992,148: 685-687
21. Tublin ME, et al. The resistive index in renal Doppler Sonography: where do we stand? AJR. 2003,180: 885-892.
22. Rawashdeh YF, et al. The intrarenal resistive index as a pathophysiological marker of obstructive uropathy. J Urol. 2001,165: 1397-1404
23. Shokeir AA, et al. Prospective comparison of nonenhanced helical computerized tomography and Doppler ultrasonography for the diagnosis of renal colic. J Urol. 2001,165: 1082-1084
24. Cronan JJ, et al. Role of the resistive index in the evaluation of acute renal obstruction.
AJR. 1995,164: 377-378
25. Shokeir AA, et al. Resistive index in renal colic: a prospective study. BJU International. 1999, 83: 378-382
2. Thompson A, et al. The use of renal scintigraphy in assessing the potential for recovery in the obstructed renal tract in children. BJU International. 2001,87: 853-856
3. Konda R, et al. Ultrasound grade of hydronephrosis and severity of renal cortical damage on ~(99m)Technetium dimercaptosuccinic acid renal scan in infants with unilateral hydronephrosis during followup and after pyeloplasty. J Urol. 2002,167: 2159-63
4. Gupta DK, et al. Percutaneous nephrostomy in children with ureteropelvic junction obstruction and poor renal function. Urology. 2001,57(3): 547-50
5. Hussain M, Ali B, et al. Prediction of renal function recovery in obstructive renal failure due to stones. J Pak Med Assoc. 1997, 47(6): 159-61
6. Huland H, et al. A new test to predict reversibility of hydronephrotic atrophy after stable partial unilateral ureteral obstruction. J Urol. 1988, 140: 1591-4
7. George M, et al. TGF-β mRNA expression in the renal pelvis after experimental and clinical ureteropelvic junction obstruction. J Urol.1996,156: 261-266
8. Furness PD 3rd, et al. Elevated bladder urine concentration of transforming growth factor-betal correlates with upper urinary tract obstruction in children. J Urol. 1999,162(3pt2): 1033-6
9. Palmer LS, et al. Urine levels of transforming growth factor-betal in children with ureteropelvic junction obstruction. Urology. 1997,50(5): 769-73
10. Kim WJ, et al. Collagen-to smooth muscle ratio helps prediction of prognosis after pyeloplasty. J Urol. 2000,163(4): 1271-5
11. Chevalier RL, et al. Recovery following relief of unilateral ureteral obstruction in the neonatal rat. Kidney Int. 1999,55(3): 793-807
12．钱林，柳明等．肾积水肾切除原因的探讨．重庆医学．2000，29(2)：130
13．姚启盛，王晓康等．彩色多普勒超声在肾积水肾功能可复性预测中的价值．中国超声医学杂志．1996，12(10)：5-7
14．王洁，廖贤平等．肾动脉阻力指数预测上尿路梗阻肾功能的临床价值．武警医学．1999，10(7)：394-396
15. Sholceir Ahmed A et al. Partial ureteral obstruction: Role of renal resistive index in stages of obstruction and release. Urology. 1997, 49(4):528-535
16. Shokeir AA. et al. Recoverability of renal function after relief of acute complete ureteral obstruction: clinical prospective study of the role of renal resistive index. Urology 2002,59(4): 506-510
17. Chevalier RL, et al. Recovery from release of ureteral obstruction in the rat: relationship to nephrogenesis. Kidney Int. 2002, 61(6): 2033-43
18. Aziz MH, et al. In hydronephrosis less than 10% kidney function is not an indication for nephrectomy in children. Bur J Pediatr Surg. 2002,12(5): 304-7
19. Schuster T, et al. Clinical impact of differential renal function to indicate and assess pyeloplasty and the significance of coexisting vesicoureteral reflux. Clin Nucl Med. 2001,26(11): 923-9
20. Bassiouny IE: Salvage pyeloplasty in non-visualizing hydronephrotic kidney secondary to ureteropelvic junction obstruction. J Urol. 1992,148: 685-687
21. Tublin ME, et al. The resistive index in renal Doppler Sonography: where do we stand? AJR. 2003,180: 885-892.
22. Rawashdeh YF, et al. The intrarenal resistive index as a pathophysiological marker of obstructive uropathy. J Urol. 2001,165: 1397-1404
23. Shokeir AA, et al. Prospective comparison of nonenhanced helical computerized tomography and Doppler ultrasonography for the diagnosis of renal colic. J Urol. 2001,165: 1082-1084
24. Cronan JJ, et al. Role of the resistive index in the evaluation of acute renal obstruction.
AJR. 1995,164: 377-378
25. Shokeir AA, et al. Resistive index in renal colic: a prospective study. BJU International. 1999, 83: 378-382
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