Chen J H, Pu Y S, Liu S P, Chiu T Y
Department of Urology, National Taiwan University Hospital, Taipei, Republic of China.
J Urol. 1993 Jul;150(1):18-21. doi: 10.1016/s0022-5347(17)35386-7.
Duplex Doppler sonography was performed to differentiate varied degrees of obstructive uropathy by demonstrating the intrarenal arterial impedance in terms of pulsatility index and resistive index. We evaluated 56 kidneys in 28 normal subjects and 53 kidneys in 27 patients with unilateral or bilateral obstructive uropathy. The degrees of renal obstruction were determined by clinical criteria, such as excretory urography, antegrade pyelography and/or retrograde ureteral catheterization. There was excellent positive correlation between pulsatility index and resistive index values (correlation coefficient 0.77, p < 0.001). In patients with obstructive uropathy there were significant differences in pulsatility index and resistive index values between the 33 obstructed and 20 nonobstructed kidneys (p < 0.001 for both indexes). Significant differences were also found between the obstructed kidneys and the kidneys of normal subjects (p < 0.001 for both indexes) even after controlling for the age factor (p < 0.001). No difference was found between the nonobstructed kidneys of the patient group and those of normal subjects (p = 0.58 and 0.45 for pulsatility and resistive indexes, respectively). The resistive index values correlated well with the degrees of obstruction (p < 0.001). The mean resistive index values for mildly and significantly obstructed kidneys were 0.64 +/- 0.08 and 0.74 +/- 0.05, respectively. More than 93.3% of the significantly obstructed kidneys had resistive index values greater than or equal to 0.70. The obstruction may be significant and demands surgical intervention when the resistive index reaches that value. In contrast, with resistive index values of less than 0.70 renovascular resistance is minimally altered and obstruction may be mild. The results can be applied clinically to help justify the indications for surgical intervention to relieve symptoms of obstructive uropathy.
通过双功多普勒超声检查，根据搏动指数和阻力指数来显示肾内动脉阻抗，以鉴别不同程度的梗阻性尿路病。我们评估了28名正常受试者的56个肾脏以及27名单侧或双侧梗阻性尿路病患者的53个肾脏。肾梗阻程度通过排泄性尿路造影、顺行肾盂造影和/或逆行输尿管插管等临床标准来确定。搏动指数和阻力指数值之间存在极好的正相关（相关系数0.77，p < 0.001）。在梗阻性尿路病患者中，33个梗阻肾脏与20个未梗阻肾脏的搏动指数和阻力指数值存在显著差异（两个指数的p均< 0.001）。即使在控制年龄因素后（p < 0.001），梗阻肾脏与正常受试者的肾脏之间也存在显著差异（两个指数的p均< 0.001）。患者组未梗阻肾脏与正常受试者的未梗阻肾脏之间未发现差异（搏动指数和阻力指数的p分别为0.58和0.45）。阻力指数值与梗阻程度密切相关（p < 0.001）。轻度和重度梗阻肾脏的平均阻力指数值分别为0.64±0.08和0.74±0.05。超过93.3%的重度梗阻肾脏的阻力指数值大于或等于0.70。当阻力指数达到该值时，梗阻可能较为严重，需要手术干预。相比之下，阻力指数值小于0.70时，肾血管阻力变化最小，梗阻可能较轻。这些结果可应用于临床，以帮助确定缓解梗阻性尿路病症状的手术干预指征。
