【摘要】 目的探讨超声造影定量分析评价脓毒血症兔致急性肾损伤肾功能状态的价值。方法选择2018年1—2018年2月健康新西兰白兔20只,采用盲肠结扎穿孔术(CLP)制作脓毒血症兔模型。利用模型制备后0、2、4、6、12 h,抽血化验血肌(SCr)、尿素氮(Urea)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、尿损伤因子(KIM-1)、白细胞介素-18(IL-18),同时做肾脏染色病理。利用超声造影分析技术计算感兴趣区域内造影剂回声信号强度,获得肾脏灌注时间-密度(TIC)曲线及一系列反映肾脏血流灌注的参数,包括曲线上升支斜率(A)、曲线下降支斜率(α)、曲线下面积(AUC)、曲线达峰绝对值(DPI)、达峰时间(TTP),使用数字化医学成像及交互格式记录肾灌注各个时间点的数据。结果①兔肾功能的变化:CLP术后6 h,脓毒血症兔尿KIM-L、NGAL、IL-18均于6 h开始显著升高,12 h更高,均显著高于建模前(P<0.05)。建模后12 h,Scr、Urea的浓度显著升高,均明显著高于建模前(P<0.05)。②肾灌注实时观察及灌注参数分析:经肘静脉团注超声造影剂后,可以观察到肾脏由叶间动脉、弓形动脉、肾皮质、肾髓质,依顺序明显增强,随后逐渐消退。建模后4 h左右肾的肾皮质曲线下面积(279.2±55.5)dB·s较建模前(135.6±68.4)dB·D显著增大(P<0.05),达峰时间(10.5±4.9)t/s较建模前(6.3±3.7)t/s显著延长(P<0.05),另外,α、A均显著低于建模前(P<0.05),6 h、12 h更著(P<0.01),DPI于建模后6 h、12 h显著低于建模前(P<0.05),而两肾各时间点比较差异均无统计学意义(P>0.05)。结论超声造影定量分析技术可早期识别脓毒血症导致的急性肾损伤。更多还原

【Abstract】 Objective To explore the value of quantitative analysis of contrast-enhanced ultrasound in evaluating renal function in sepsis-induced acute renal injury in rabbits. Methods January 2018 to February 2018, twenty healthy New Zealand white rabbits were selected to establish sepsis rabbit models by cecal ligation and puncture(CLP). The sepsis rabbit model was made by CLP. SCr, Urea, NGAL, KIM-1 and IL-18 were tested at 0, 2, 4, 6 and 12 hours after the model was prepared. Kidney staining and pathology were performed at the same time. Contrast-enhanced ultrasound was used to calculate the echo intensity of contrast medium in the region of interest. TIC curves and a series of parameters reflecting renal perfusion, including A, α, AUC, DPI and TTP were obtained. Data of each time point of renal perfusion were recorded by digital medical imaging and interactive format. Results 1. Changes of renal function in rabbits:6 h after CLP surgery, urinary KIM-L, NGAL, and il-18 of sepsis rabbits were significantly increased at 6 h and 12 h, all significantly higher than before the modeling(P <0.05). At 12 h after modeling, concentrations of Scr and Urea were significantly increased, both significantly higher than before modeling(P <0.05). 2.real-time observation of renal perfusion and analysis of perfusion parameters: as shown in table 2, after ultrasound contrast agent was injected through the cubital vein group, the kidney by interlobar artery, arch artery, renal cortex, renal medulla could be observed, in order to significantly enhance, and then gradually subsided. Modeling about 4 h after re-nal cortex of the kidney area under the curve(279.2 ±55.5) dB·s, s A modeling(135.6±68.4) dB·s before the dB, s increased significantly(P<0.05), tmax(10.5±4.9)t/s before the modeling(6.3±3.7) t/s significantly extended(P< 0.05), in addition, alpha, A modeling were significantly lower than before(P<0.05), 6, 12 h more(P<0.01), DPI in modeling modeling after 6 and 12 h was significantly lower than before(P<0.05), There was no significant difference between the two kidneys at all time points(P>0.05). Conclusion Contrast-enhanced ultrasonography quantitative analysis technique can identify early acute renal injury caused by sepsis.更多还原