Argalia G, D'ambrosio F, Mignosi U, Migliorini D, Lucarelli F, Giuseppetti G M, Fanciulli E, Mioli V
Cattedra di Radiologia, Università degli Studi di Ancona.
Radiol Med. 1995 Apr;89(4):464-9.
This study was aimed at finding a Doppler parameter to distinguish, among medical nephropathies, the ones with glomerular from those with vascular or tubulointerstitial involvement. Therefore, 32 patients (20 men and 10 women, average age: 43 years, range: 10-77 years) with clinical and laboratory signs of medical renal disease were examined with color-Doppler US. The resistive index (RI, n.v. < 0.70), as calculated from the Doppler waveform signal was especially considered to assess eventual significant changes differentiating renal diseases according to the different kinds of involvement. RI values were compared with renal biopsy findings, creatininemia levels and clinical and laboratory variables as hematuria and proteinuria. Histology diagnosed 18 glomerulonephritis, 4 glomerulonephritis with interstitial involvement and 10 vascular and tubulointerstitial nephroses, with 1 tubular necrosis. Doppler US demonstrated a normal RI value in 17/18 patients with glomerulonephrosis (mean value: 0.59 +/- 0.05). In one case only, even though biopsy indicated the involvement of one glomerulus only (membranous GN II stage), RI was high--i.e., 0.79. In 4 patients with simultaneous glomerular and interstitial involvement, the mean RI value was 0.17 +/- 0.01. In the 10 cases of tubulointerstitial or vascular nephrosis, the RI was 0.83 +/- 0.07. As far as the correlation between creatininemia levels and RI is concerned, in 8 patients with high values (1.5-8 mg/dl), the mean RI was 0.72 +/- 0.08 and only a weak correlation was found between the RI and the renal failure degree as expressed by creatininemia levels. Therefore, the RI seems to be related more to the site of the disease in the renal field than to renal failure degree. Doppler US seems to be capable of characterizing medical nephrosis, distinguishing glomerular from vascular or tubulointerstitial involvement. In this application area, the combined use of Doppler and color-Doppler US allowed each examination to be performed in a relatively short time--i.e., 30 minutes on the average.
本研究旨在寻找一种多普勒参数，以在各种医学肾病中区分肾小球受累的肾病与血管或肾小管间质受累的肾病。因此，对32例有医学肾脏疾病临床和实验室体征的患者（20名男性和10名女性，平均年龄：43岁，范围：10 - 77岁）进行了彩色多普勒超声检查。根据多普勒波形信号计算得出的阻力指数（RI，正常范围<0.70）被特别用于评估根据不同受累类型区分肾脏疾病的最终显著变化。将RI值与肾活检结果、血肌酐水平以及血尿和蛋白尿等临床和实验室变量进行比较。组织学诊断出18例肾小球肾炎、4例伴有间质受累的肾小球肾炎、10例血管性和肾小管间质性肾病以及1例肾小管坏死。多普勒超声显示17/18例肾小球肾病患者的RI值正常（平均值：0.59±0.05）。仅在1例中，尽管活检仅显示一个肾小球受累（膜性肾小球肾炎II期），但RI值较高，即0.79。在4例同时有肾小球和间质受累的患者中，平均RI值为0.17±0.01。在10例肾小管间质或血管性肾病患者中，RI为0.83±0.07。就血肌酐水平与RI的相关性而言，在8例血肌酐值较高（1.5 - 8mg/dl）的患者中，平均RI为0.72±0.08，且RI与血肌酐水平所表示的肾衰竭程度之间仅发现弱相关性。因此，RI似乎更多地与肾脏病变部位相关，而非与肾衰竭程度相关。多普勒超声似乎能够对医学肾病进行特征性描述，区分肾小球受累与血管或肾小管间质受累。在该应用领域，多普勒超声和彩色多普勒超声的联合使用使得每次检查能够在相对较短的时间内完成，平均为30分钟。
