肾动脉超声血流动力学参数与非增强磁共振评估肾动脉狭窄及解剖异常的临床应用

doi:10.16138/j.1673-6087.2025.04.03

摘要/Abstract

摘要：

目的：对比肾动脉超声血流动力学参数与非增强磁共振在评估肾动脉狭窄及解剖异常中的临床价值。方法：选取149例慢性肾脏病（chronic kidney disease, CKD）患者，通过肾动脉非增强磁共振血管成像（non-contrast enhanced magnetic resonance angiography, NCE-MRA）评估肾动脉狭窄及解剖变异，彩色多普勒超声检测肾动脉各段血流动力学参数，肾功能评估采用核素肾动态显像和CKD流行病学合作研究（Chronic Kidney Disease Epidemiology Collaboration, CKD-EPI）方程式计算估算的肾小球滤过率（estimated glomerular filtration rate, eGFR）2种方式。结果：149例患者CKD分期1期17例（11.4%）、2期39例（26.2%）、3期44例（29.5%）、4期17例（11.4%）、5期32例（21.5%）。起始段肾动脉狭窄患者阻力指数（resistance index, RI）明显高于无狭窄患者（P=0.000），收缩期峰值速度（peak systolic velocity，PSV）无统计学差异（P=0.443）；有无中段狭窄患者2组间PSV及RI差异均无统计学意义（P=0.190、P=0.088）。解剖变异组起始段及中段的PSV和RI与无变异组差异均无统计学意义（P>0.05）。肾动脉起始段无狭窄侧eGFR明显高于狭窄侧（Z=2.980，P=0.029），中段无狭窄侧eGFR明显高于狭窄侧（Z=4.025，P=0.001），解剖变异侧与非变异侧eGFR差异无统计学意义（Z=0.579，P=0.550）。结论：彩色多普勒超声PSV和RI对肾动脉起始部狭窄诊断价值高于肾动脉中段狭窄，对肾动脉解剖学变异无诊断价值。无论是肾动脉起始段还是中段狭窄，均导致同侧eGFR下降，肾动脉解剖变异则不影响同侧肾脏eGFR。

关键词: 彩色多普勒超声, 非增强磁共振血管成像, 肾动脉解剖异常, 肾动脉狭窄

Abstract:

Objective To compare the clinical value of renal artery ultrasound hemodynamic parameters and non-enhanced magnetic resonance in evaluating renal artery stenosis and anatomical abnormalities. Methods A total of 149 patients with chronic kidney disease(CKD) were enrolled. Renal artery stenosis and anatomical variations were evaluated by non-enhanced renal artery magnetic resonance angiography (NEC-MRA). Color Doppler ultrasound was used to detect hemodynamic parameters of each segment of the renal artery. Renal function assessment was conducted through two methods: radionuclide renal dynamic imaging and the calculation of the estimated glomerular filtration rate (eGFR) using the CKD Epidemiology Collaboration (CKD-EPI) study equation formula. Results Among the 149 patients in this study, 17 cases (11.4%) were at CKD stage 1, 39 cases (26.2%) at stage 2, 44 cases (29.5%) at stage 3, 17 cases (11.4%) at stage 4, and 32 cases (21.5%) at stage 5. The resistance index (RI) of patients with initial renal artery stenosis was significantly higher than that of patients without stenosis (P=0.000), while there was no statistically significant difference in peak systolic velocity (PSV) (P= 0.443). There was no statistical difference in PSV and RI between the two groups with or without midstream stenosis (P=0.190, P=0.088). There was no significant difference in PSV and RI between the initial and middle segments of the anatomical variation group and the non-variation group (P > 0.05). The eGFR on the non-stenotic side of the initial segment of the renal artery was significantly higher than that on the stenotic side (Z=2.98, P=0.029), and eGFR on the non-stenotic side in the middle segment was significantly higher than that on the stenotic side (Z=4.025, P=0.001). There was no statistical difference in eGFR between the anatomical variant side and the non-variant side (Z=0.579, P=0.550). Conclusions Color Doppler ultrasound PSV and RI show higher value in diagnosing initial renal artery stenosis than middle renal artery stenosis and have no diagnostic value for anatomic variation of renal artery. Both initial and middle renal artery stenosis leads to a decrease in the ipsilateral renal GFR, while variations in renal artery anatomy does not affect ipsilateral renal GFR.

Key words: Color Doppler ultrasound, Non-contrast-enhanced magnetic resonance angiography, Anatomic abnormalities of the renal artery, Renal artery stenosis

孙杰, 谢洁, 马宏昆, 刘宝莲, 陈学英, 黄文洁, 何水林, 陈孜瑾, 张文. 肾动脉超声血流动力学参数与非增强磁共振评估肾动脉狭窄及解剖异常的临床应用[J]. 内科理论与实践, 2025, 20(04): 276-281.

SUN Jie, XIE Jie, MA Hongkun, LIU Baolian, CHEN Xueying, HUANG Wenjie, HE Shuilin, CHEN Zijin, ZHANG Wen. Clinical application of renal artery ultrasound monitoring hemodynamic parameters and non-contrast-enhanced magnetic resonance angiography in evaluation of renal artery stenosis and anatomic abnormalities[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(04): 276-281.

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项目	整体人群	RAS		肾动脉变异
项目	整体人群	单侧	双侧	单侧	双侧
总例数[n（%）]	149（100.0）	32（21.5）	11（7.4）	52（34.9）	11（7.4）
男性[n（%）]	108（72.5）	29（19.5）	5（3.4）	42（28.1）	9（6.0）
年龄（岁）	57.4±15.6	61.6±13.8	76.2±8.6	53.5±15.4	54.2±18.1
原发病[n（%）]
慢性肾炎	51（34.2）	10（6.7）	2（1.3）	12（8.1）	2（1.3）
糖尿病肾病	31（20.8）	7（4.7）	3（2.0）	17（11.4）	3（2.0）
高血压肾病	34（22.8）	12（8.1）	4（2.7）	11（7.4）	3（2.0）
其他原发病	33（22.2）	2（1.3）	2（1.3）	12（8.1）	3（2.0）
合并症[n（%）]
高血压	125（83.9）	28（18.8）	10（6.7）	43（28.9）	6（4.0）
糖尿病	52（34.9）	14（9.4）	4（2.7）	20（13.4）	5（3.4）
eGFR [mL/（min·1.73 m²）]	47.98±31.22	41.68±26.10	39.73±23.53	43.90±31.47	62.35±32.82
GFR *(mL/min)（n=99）	48.09±23.94	39.29±15.93	34.42±13.83	49.28±26.17	46.17±27.61

参数	肾动脉起始段无狭窄 (n=263)	肾动脉起始段狭窄 (n=35)	t/Z	P	肾动脉中段无狭窄 (n=277)	肾动脉中段狭窄 (n=21)	t/Z	P
PSV（cm/s）	74(54，90)	53.5(42，78)	0.767	0.443	41(33，50)	40(33，44)	1.310	0.190
RI	0.689±0.05	0.758±0.016	-4.252	0.000	0.644±0.006	0.678±0.018	-1.715	0.088

参数	无副肾动脉+提前分支 (n=224)	有副肾动脉+提前分支 (n=74)	t/Z	P
肾动脉起始段PSV（cm/s）	71.5（53，90）	71（48，90）	0.585	0.559
肾动脉起始段RI	0.701±0.006	0.687±0.009	1.232	0.219
肾动脉中段PSV（cm/s）	40.5（33，50）	41（31.5，49）	-0.616	0.538
肾动脉中段RI	0.648±0.006	0.644±0.010	0.366	0.715

肾动脉	r	P
起始段RI	-0.446	0.000
起始段PSV	0.302	0.000
中段RI	-0.294	0.000
中段PSV	0.344	0.000