Application value of elastic modulus in diagnosis of early primary nephrotic syndrome and its correlation with renal function indexes
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摘要:
目的 探讨剪切波弹性成像弹性模量值在早期原发性肾病综合征（PNS）患者与健康者对比研究及肾功能判定指标相关性中的应用价值。 方法 选取经临床及病理证实且符合早期PNS慢性肾病1期，即肾功能正常（血尿素氮及血肌酐指标正常）阶段的病例30例，分析检测PNS患者双肾弹性模量值特征，另取30例健康者双侧肾脏作为对照组，分析两组肾弹性模量值的差异及PNS组双肾弹性模量平均值（Emean）与24 h尿蛋白量和血清β2-微球蛋白量的相关性。 结果 PNS组与对照组双侧肾脏长度、厚度、肾皮质组间比较，差异无统计学意义（P > 0.05）。PNS组双肾弹性模量平均值（Emean）、最大值（Emax）、最小值（Emin）、弥散度均高于对照组（P < 0.05）。Emax=22.45 kPa时，鉴别诊断两组的敏感度、特异性、准确率分别为80.0%、93.3%、86.7%，曲线下面积最大（0.857），诊断效能最高。PNS组Emean与24 h尿蛋白量和血清β2-微球蛋白量呈正相关，与血尿素氮和血肌酐无相关性。 结论 剪切波弹性成像弹性模量值量化分析技术为无创性判断早期PNS肾脏硬度变化及损伤程度提供病理基础及分子影像学依据，为早期PNS的诊断与鉴别提供可靠依据，亦可联合24 h尿蛋白量和血清β2-微球蛋白量对早期PNS肾功能损伤作出有价值的评估。 Abstract:Objective To investigate the application value of shear wave elastography elastic modulus value in the comparative study between patients with early primary nephrotic syndrome (PNS) and healthy subjects and the correlation of renal function indicators. Methods Patients with early PNS CKD stage1 [Patients with normal renal function (blood urea nitrogen and serum creatinine) in normal stage] confirmed by clinical and pathological examination were involved. The characteristics of renal elastic modulus values in 30 PNS patients were analyzed, and the bilateral kidneys of 30 healthy subjects were selected as the control group. The difference of renal elastic modulus values between the two groups and the correlation between the mean renal elastic modulus (Emean) in the PNS group and the 24-hour urinary protein volume and serum β2-microglobulin volume (β2-MG) were analyzed. Results There was no significant difference of renal length, thickness and renal cortex of bilateral kidneys between PNS group and control group (P > 0.05). The mean elastic modulus (Emean), maximum value (Emax), minimum value (Emin) and dispersion of PNS group were higher than those of control group (P < 0.05). When the maximum elastic modulus was 22.45 kPa, the sensitivity, specificity and accuracy of the two groups were 80.0%, 93.3% and 86.7%, respectively. The area under the curve was the largest (0.857), the diagnostic efficiency was the highest. In PNS group, Emean was positively correlated with 24-hour urinary protein volume and serum β2-microglobulin volume, but there was no correlation with blood urea nitrogen and serum creatinine. Conclusion The quantitative analysis technique of shear wave elastography elastic modulus value can provide pathological basis and molecular imaging basis for noninvasive determination of the changes of renal hardness and the degree of injury in early PNS, and provide reliable basis for diagnosis and differentiation of early PNS. It can provide valuable assessment of renal function injury in early PNS by combining 24-hour urinary protein volume and serum β2-microglobulin volume. -
图 1 PNS组与对照组左侧肾脏SWE图
A：PNS组, Emean为14.41 kPa, Emax为34.31 kPa, Emin为9.54 kPa, SD为5.68 kPa; B: 对照组, Emean为12.25 kPa, Emax为18.29 kPa, Emin为7.31 kPa, SD为2.81 kPa.
Figure 1. SWE images of left kidney in PNS group and control group.
图 3 弹性模量值诊断肾病的操作者工作特征曲线
Figure 3. Operator operating characteristic curve of nephropathy diagnosed by elastic modulus value.
图 4 PNS组Emean与24 h-UTP、β2-MG相关性散点图
A: PNS组Emean与24 h-UTP相关性散点图; B: PNS组Emean与β2-MG相关性散点图.
Figure 4. Scatter diagram of correlation between Emean and 24 H-UTP and β2-MG in PNS group.
表 1 两组肾脏的长度、厚度和肾皮质厚度比较
Table 1. The length, thickness and cortical thickness of the kidney were compared between the two groups (n=30, mm, Mean±SD)
部位 组别 肾脏长度 肾脏厚度 肾皮质厚度 右肾 PNS组 103.97±9.09 37.4±9.59 10.26±0.92 对照组 107.23±7.30 36.93±9.16 10.61±0.71 t -1.534 0.193 -1.615 P 0.13 0.848 0.112 左肾 PNS组 104.70±10.53 38.20±9.41 10.32±1.06 对照组 107.03±8.50 39.37±9.83 10.63±0.86 t -0.944 -0.47 -1.229 P 0.349 0.64 0.224 PNS: 原发性肾病综合征. 
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表 2 PNS组与对照组组内双侧肾脏弹性模量值比较
Table 2. Bilateral renal elastic modulus values were compared between PNS group and control group (n=30, kPa, Mean±SD)
组别 部位 Emean Emax Emin SD PNS组 左肾 14.52±4.09 30.13±9.03 9.82±4.41 5.45±1.98 右肾 14.56±4.18 30.54±8.32 9.41±4.54 5.38±2.04 t -0.28 -1.216 1.41 0.551 P 0.781 0.234 0.169 0.586 对照组 左肾 11.40±2.41 20.25±4.42 6.94±2.82 3.81±1.92 右肾 11.47±2.46 20.19±3.84 6.71±2.90 3.75±1.93 t -0.269 0.151 1.477 0.699 P 0.79 0.881 0.15 0.49 Emean: 弹性模量平均值; Emax: 弹性模量最大值; Emin: 弹性模量最小值; SD: 弥散度.
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表 3 PNS组与对照组肾脏弹性模量值最终测值组间比较
Table 3. Comparison between the PNS group and the control group of renal elastic modulus values (n=30, kPa, Mean±SD)
组别 Emean Emax Emin SD PNS组 14.66±4.14 30.34±8.64 9.62±4.40 5.42±1.97 对照组 11.18±2.56 19.32±2.80 6.42±2.42 3.78±1.91 t 3.724 5.829 2.927 3.264 P 0.001 < 0.001 0.005 0.002
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表 4 PNS组Emean值(kPa)与实验室各指标相关性分析
Table 4. Correlation analysis of Emean value(kPa) and laboratory indexes in PNS group
指标 r P 24 h-UTP (g/24 h) 0.635 < 0.001 β2-MG (mg/L) 0.366 0.046 BUN (mmol/L) -0.033 0.862 Scr (μmol/L) -0.065 0.733 24 h-UTP: 24 h尿蛋白量; β2-MG: β2-微球蛋白量; BUN: 血尿素氮; Scr: 血肌酐.
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