目的 探讨超声造影评价脊髓损伤并发肾积水患者肾功能的临床价值。方法 2015年10月至2018年11月,选择脊髓损伤并发肾积水并且肾功能下降患者23例(脊髓损伤组)和健康志愿者19例(对照组),双肾进行超声造影检查并与肾动态显像结果进行对照分析。利用软件分析采集的超声造影图像,在肾皮质选取感兴趣区(ROI),绘制时间强度曲线。以达峰时间(TTP)、峰值强度(DPI)、上升支斜率(A)和曲线下面积(AUC)为自变量,肾动态显像结果为因变量做Logistics回归,再进行ROC曲线分析。结果 两组血肌酐和尿素比较均无显著性差异(P> 0.05)。脊髓损伤组TTP显著长于对照组(t = 5.068, P < 0.001),A和AUC明显低于对照组( t > 3.784, P < 0.01)。AUC是肾功能损伤的影响因素( P <0.01)。AUC越小,肾损伤的可能性越大,敏感性和特异性之和最大为1.759,对应的AUC为982.518 dBs。结论 超声造影可以评价脊髓损伤并发肾积水患者肾功能。时间强度曲线AUC减小,提示肾功能受损。

Objective To apply contrast-enhanced ultrasound in renal function evaluation for patients with spinal cord injury complicated with hydronephrosis.Methods From October, 2015 to November, 2018, 23 patients with spinal cord injury complicated with hydronephrosis and renal disfunction (spinal cord injury group) and 19 cases of normal kidneys (control group) accepted contrast-enhanced ultrasonography and the image was analyzed with software. The region of interest (ROI) in the renal cortex, and the time intensity curve was drawn. Logistic regression was performed with time to initial peak (TTP), peak intensity (DPI), slope of ascending time (A), area under the curve (AUC) as the independent variable and renography as the dependent variable. The data was analyzed with ROC.Results There was no significant difference in serum creatinine and ureophil between two groups (P > 0.05). TTP was longer ( t = 5.068, P < 0.001), and A and AUC were lower ( t > 3.784, P < 0.01) in the spinal cord injury group than in the control group. AUC was the factor related to renography ( P < 0.01). The smaller the AUC was, the greater the likelihood of kidney damage was. The sum of sensitivity and specificity was 1.759 and the corresponding AUC was 982.518 dBS. Conclusion Contrast-enhanced ultrasound can evaluate renal function of patients with spinal cord injury complicated with hydronephrosis. The decrease in AUC of the time-intensity curve indicates that the renal function is impaired.