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目的 评价声触诊组织定量(virtual touch tissue quantification, VTQ)技术在IgA肾病(IgA nephropathy, IgAN)的应用价值。 方法 选择2012年1月1日至4月30日北京协和医院经肾活检证实的28例IgAN患者, 对所有患者左肾进行常规超声(肾脏长径、皮质厚度、叶间动脉阻力指数)及VTQ超声[剪切波速度(shear wave velocity, SWV)]检查。分析常规超声与VTQ指标间, 以及各超声指标与患者临床/病理指标-慢性肾脏病(chronic kidney disease, CKD)分期、Lee分级、肾小球硬化指数(glomerular sclerosis index, GSI)、肾小管萎缩(tubular atrophy, TA)以及肾间质纤维化(interstitial fibrosis, IF)的相关性。 结果 IgAN患者肾脏常规超声指标与其VTQ结果、临床/病理指标无显著相关性(P > 0.05);VTQ测定的SWV与CKD分期(r=-0.382, P=0.045)、Lee分级(r=-0.407, P=0.031)及IF(r=-0.397, P=0.036)呈负相关, 与GSI和TA无显著相关性(P > 0.05)。 结论 通过VTQ技术测定的肾皮质SWV与多项临床/病理指标存在相关性, 这一新型超声弹性成像技术的临床意义值得进一步研究。 Abstract:Objective To evaluate the application of virtual touch tissue quantification (VTQ) technique in immunoglobulin A nephropathy (IgAN). Methods A total of 28 patients were included in present study who underwent kidney biopsy in Peking Union Medical College Hospital from January 1, 2012 to April 30, 2012. On sonography, conventional[length(L), thickness (T), resistive index(RI)], and VTQ (shear wave velocity, SWV) parameters of left kidney were measured. Then using Spearman correlation analysis, the correlations between SWV and clinicopathologic parameters[chronic kidney disease(CKD) stage, Lee grade, glomerular sclerosis index (GSI), tubular atrophy(TA), interstitial fibrosis(IF)] and the association of SWV and conventional ultrasound measurements were evaluated. Results No significant correlation was found between conventional ultrasound measurements and SWV, as well as clinicopathologic parameters (all P > 0.05). However, Spearman analysis indicated that SWV showed significant correlations with CKD stage (r=-0.382, P=0.045), Lee grade (r=-0.407, P=0.031), and IF (r=-0.397, P=0.036). Conclusions As a novel sono-elastography technique, VTQ correlates with multiple clinicopathologic parameters by measuring renal cortical stiffness. Therefore it is of great value in clinical application and warrants further investigation. -
图 2 患者女，39岁，Lee分级5级
A.肾皮质VTQ测量(SWV 2.97 cm/s)；B.肾小球(红色)内系膜基质增多、毛细血管袢消失、呈玻璃变性(GSI 2.86，PAS染色，×100)；C.肾小管(黑色)上皮细胞体积缩小、基底膜增厚、管腔狭窄、形态扭曲变形(TA 0.75，PASM染色，×100)；D.肾间质胶原纤维(绿色)明显增生(IF 0.80，Masson染色，×100) VTQ、SWV、GSI、TA、IF：同表 1
表 1 IgA肾病患者左肾超声/临床/病理检查结果
病例 年龄 性别 常规超声指标 VTQ指标
SWV(cm/s)临床指标
CKD分期病理指标 L(cm) T(cm) RI Lee分级 GSI TA IF 1 36 M 11.62 0.61 0.63 3.12 1 2 1.59 0.35 0.30 2 31 M 11.23 0.62 0.58 2.79 1 3 1.50 0.30 0.20 3 24 F 11.50 0.62 0.46 3.08 1 3 0.43 0.15 0.10 4 30 M 11.35 0.65 0.59 2.70 1 3 1.00 0.05 0.05 5 29 F 11.99 0.56 0.59 3.34 1 3 0.56 0.08 0.10 6 16 M 12.20 0.58 0.46 2.98 1 3 0.28 0.15 0.08 7 36 F 11.76 0.65 0.54 3.17 1 3 1.32 0.20 0.20 8 35 F 10.73 0.71 0.59 3.50 1 3 0.72 0.05 0.05 9 34 F 11.82 0.76 0.56 2.60 1 3 1.10 0.10 0.30 10 45 M 10.98 0.95 0.59 2.67 1 3 1.00 0.20 0.20 11 34 F 11.99 0.52 0.59 3.16 1 3 0.83 0.20 0.10 12 33 M 11.08 0.65 0.53 1.70 1 4 1.47 0.35 0.30 13 29 F 10.92 0.63 0.58 2.54 1 4 1.17 0.20 0.10 14 48 F 11.34 0.66 0.54 2.83 1 4 2.21 0.60 0.45 15 48 M 12.67 0.79 0.52 3.18 1 4 1.42 0.30 0.20 16 28 F 12.86 0.67 0.52 2.62 1 4 1.39 0.50 0.50 17 22 F 11.59 0.62 0.53 3.10 1 4 2.01 0.50 0.30 18 34 F 10.98 0.54 0.59 2.87 1 4 1.52 0.50 0.40 19 27 M 10.54 0.74 0.50 2.77 2 3 0.50 0.05 0.10 20 30 F 11.19 0.82 0.62 2.29 2 4 1.90 0.50 0.60 21 54 F 10.49 0.65 0.56 2.22 2 4 0.88 0.50 0.35 22 50 F 10.98 0.62 0.57 2.25 2 4 0.90 0.40 0.30 23 52 M 11.07 0.64 0.58 1.80 2 4 0.82 0.20 0.40 24 25 F 11.12 0.49 0.55 2.81 3 4 2.42 0.65 0.58 25 44 F 10.45 0.70 0.61 3.08 3 4 1.00 0.60 0.50 26 39 F 12.74 0.66 0.49 2.97 3 5 2.86 0.75 0.80 27 19 M 13.08 0.75 0.53 1.92 4 4 3.00 0.80 0.70 28 29 F 10.59 0.63 0.58 1.92 4 4 3.00 0.70 0.80 L：长径；T：皮质厚度；RI：叶间动脉阻力指数；VTQ：声触诊组织定量；SWV：剪切波速度；CKD：慢性肾脏病；GSI：肾小球硬化指数；TA：肾小管萎缩；IF：肾间质纤维化; M:男；F:女 
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