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Title: [Characteristics of renal cortical perfusion and its association with renal function among elderly patients with renal artery stenosis].
Author: Ma N, Sun YJ, Ren JH, Wang SY, Zhang YW, Ji XP, Li MP, Guo FJ.
Journal: Zhonghua Xin Xue Guan Bing Za Zhi; 2019 Aug 24; 47(8):628-633. PubMed ID: 31434434.
Abstract:
Objective: To evaluate the characteristics of renal cortical blood perfusion assessed by contrast-enhanced ultrasound (CEUS) in elderly patients with renal artery stenosis (RAS) and its relationship with renal function. Methods: Ninety-three elderly patients diagnosed with RAS, who were admitted in Beijing Hospital during June 2017 and December 2018, were retrospectively enrolled. According to the degree of RAS, 186 renal arteries were divided into normal renal artery group (n=79), mild RAS group (30% to 49%, n=59), moderate RAS group (50% to 70%, n=33), and severe RAS group (70% to 99%, n=15). Renal cortical blood perfusion and renal glomerular filtration rate (GFR) were measured by CEUS and radionuclide renal dynamic imaging. According to the renal GFR, 186 kidneys were divided into normal renal function group (GFR≥35 ml/min, n=42) and mild renal insufficiency group (35 ml/min>GFR≥25 ml/min, n=51), moderate renal insufficiency group (25 ml/min>GFR≥15 ml/min, n=75) and severe renal insufficiency group (GFR<15 ml/min, n=18). The renal cortical blood perfusion time-intensity curve (TIC) and related parameters were analyzed, including the area under the curve (AUC), the slope of the ascending branch (A), the peak intensity (PI), the peak time (TTP) and the mean transit time (MTT), the kidneys of different RAS groups and patients with different renal function groups were analyzed. Pearson correlation analysis was used to evaluate the correlation between renal cortical blood perfusion parameters and renal GFR. Results: (1) Renal cortical blood perfusion and GFR: CEUS showed that parameter A of TIC was significantly reduced, while TTP was prolonged in the mild renal artery stenosis group compared with the normal renal artery group (both P<0.05), GFP was similar between the two groups. Cortical perfusion parameters, such as AUC, A, PI and GFR were significantly lower, while TTP and MTT were significantly prolonged in the moderate and severe renal artery stenosis group than in the normal and mild stenosis groups (all P<0.05). Compared with the moderate stenosis group, AUC, A, PI and GFR were significantly lower while TTP, MTT were significantly prolonged in the severe renal artery stenosis group (all P<0.05). (2) TIC showed that the renal perfusion parameters, AUC, PI and A were significantly lower, while TTP was significantly longer in the mild renal dysfunction group than in the normal renal function group (all P<0.001). The changes aggravated in proportion with renal dysfunction. (3) Correlation between perfusion parameters and GFR: Pearson correlation analysis showed that the AUC (r=0.774, P<0.05), A (r=0.815, P<0.05) and PI (r=0.772, P<0.05) were positively correlated with GFR; serum creatinine level (r=-0.841, P<0.05), renal function grading (r=-0.731, P<0.05), TTP (r=-0.803, P<0.05) and MTT (r=-0.741, P<0.05) were negative correlated with GFR. The degree of stenosis was negatively correlated with GFR (r=-0.427, P<0.05). Conclusion: Cortical perfusion parameters differ significantly among patients with various degree of RAS and renal dysfunction. The renal cortical blood perfusion parameters are correlated with renal GFR. 目的： 探讨老年肾动脉狭窄患者分肾皮质血流灌注的特点及其与分肾功能的关系。 方法： 该研究为回顾性研究。入选2017年6月至2018年12月在北京医院就诊的老年肾动脉狭窄患者93例，以分肾为研究对象，遂共有186个肾脏。依据肾动脉狭窄程度将186个肾脏分为肾动脉正常组（n=79）、轻度肾动脉狭窄组（肾动脉狭窄30%~49%，n=59）、中度肾动脉狭窄组（肾动脉狭窄50%~69%，n=33）和重度肾动脉狭窄组（肾动脉狭窄70%~99%，n=15）；根据分肾肾小球滤过率（GFR）将186个肾脏分为肾功能正常组（GFR≥35 ml/min，n=42）、轻度肾功能不全组（35 ml/min>GFR≥25 ml/min，n=51）、中度肾功能不全组（25 ml/min>GFR≥15 ml/min，n=75）和重度肾功能不全组（GFR<15 ml/min，n=18）。采用超声造影技术（CEUS）和核素肾动态显像分别检测分肾皮质血流灌注情况和分肾GFR，分析分肾皮质血流灌注时间-强度曲线（TIC）及相关参数，包括曲线下面积（AUC）、上升支斜率（A）、峰值强度（PI）、达峰时间（TTP）和平均渡越时间（MTT），分析不同肾动脉狭窄组和不同肾功能组的肾皮质血流灌注特点。采用Pearson相关分析分析分肾皮质血流灌注参数与分肾GFR的相关性。 结果： （1）不同肾动脉狭窄程度组的分肾皮质血流灌注和GFR：与肾动脉正常组比较，轻度肾动脉狭窄组分肾TIC皮质灌注参数A较小、TTP较长（P均<0.05），但GFR差异无统计学意义（P>0.05）。中和重度肾动脉狭窄组分肾皮质灌注参数AUC、A、PI和GFR均较肾动脉正常组和轻度肾动脉狭窄组低（P均<0.05），TTP和MTT均较长（P均<0.05）。而重度肾动脉狭窄组AUC、A、PI和GFR均较中度肾动脉狭窄组低（P均<0.05），TTP和MTT均较长（P均<0.05）。（2）不同程度肾功能不全的分肾皮质血流灌注：轻度肾功能不全组分肾AUC、PI和A均明显小于肾功能正常组（P均<0.001），TTP明显长于肾功能正常组肾脏（P<0.001），且随着肾功能不全加重上述参数变化越发明显。（3）分肾皮质血流灌注参数与分肾GFR相关性：分肾皮质血流灌注参数AUC（r=0.774，P<0.05）、A（r=0.815，P<0.05）和PI（r=0.727，P<0.05）与GFR呈显著正相关，分肾功能分级（r=-0.731，P<0.05）、TTP（r=-0.803，P<0.05）和MTT（r=-0.741，P<0.05）与GFR呈显著负相关，而病变狭窄程度与GFR呈弱相关（r=-0.427，P<0.05）。 结论： 老年肾动脉狭窄患者患肾皮质血流灌注参数有明显改变，且皮质血流灌注参数均与分肾功能显著相关。.

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