| Objective: To detect the renal elasticity in patients with hypertension by the the acoustic radiation force impulse-virtual touch quantification(ARFI-VTQ)technique,and the results were compared with other related indexes,then evaluate whether the technique can provide some diagnostic value for early renal injury in hypertensive patients.Methods : Basic data: With the consent of the hospital Ethics Committee,according to the diagnostic criteria of essential hypertension,we selected 53 patients with hypertension in the Affiliated Hospital of Southwest Medical University from January 2017 to October 2017 as the research object,all patients had informed consent,and underwent kidney elasticity examination,fundus examination and related biochemical examination.The control group,50 cases of healthy adults.Instrumentation and Inspection methods: Use Siemens Acuson S3000 Ultrasonic diagnostic instrument,equipped with VTQ technology quantitative analysis system.All subjects have an empty stomach of more than 8h,take the appropriate best posture,fully exposed to the two sides of the kidney examination area,the first routine two-dimensional ultrasound examination,double kidney morphology,size,echo,medullary thickness,the skin medulla demarcation is not clear to the thickness of the measured material,and then the color Doppler examination,observation of the blood flow of the double kidney,The Systolic Peak Velocity(PSV),End-diastolic Velocity(EDV),Resistance Index(RI)and so on were measured by spectrum Doppler.Finally,the acoustic radiation force impulse-virtual touch quantification technique was examined in the lateral position to examine the double kidney and to obtain the largest long axial section of the kidney,So that the probe was pressed against the skin under its own gravity without pressure,instructed patients naturally relaxes then breath-holding,after the image was clear and stable,pressed the “update” key,made measurement of kidney cortex,the medulla,the kidney sinus shear wave velocity values(Vs),the skin medulla boundary was not clear the measurement real shear wave velocity values(Vs).Each site repeatedly measured the effective measurements at least five times and then calculated the average.Kept the disstance between the each ROI and probe less than 8cm,record the measured value after the map.All the inspectors then did fundus examination,according to the Keith-wagener Fundus classification method,and recorded the patient’s age,the most hypertensive value,the course of the day,blood pressure value,blood creatinine(SCr),urea nitrogen(BUN),glomerular filtration rate(GFR),urinary protein,urine micro-albumin,Urine α1-microglobulin and other indicators.After data collection was completed,the renal Vs value was grouped according to the following indicators:(1)According to whether there was hypertension,divided into observation group and control group,to understand the difference between the Vs value of hypertension and control group.(2)According to the level of hypertension divided the observation group into 1,2,3 level group and normal group,,to understand the difference of renal Vs value among hypertensive groups.(3)According to the different grading of fundus to classify observation group and control group of normal,Level I,II and III,and to know if there was any difference in renal Vs value among different group of fundus.While analysis of factors such as age,gender,the renal side,course length,renal volume change on renal Vs value,and correlation analysis between renal Vs value and clinical common indexes.Correlation data of arteriae interlobares renis: PSV,EDV,RI and clinical related biochemical indexes: SCr,BUN,urine microalbuminuria,urine routine protein,urine α1-microglobulin,GFR.Statistical analysis was performed after data collection.Results:(1)The Vs value of the renal in the observation group was lower than that in the control group(p<0.05),and the Vs value of the renal in the observation group was: renal cortex > renal medulla > renal sinus(P <0.05).(2)There were statistically significant differences in the Vs value of renal in different levels of blood pressure(P <0.05),in which renal parenchyma Vs value: 2,3 levels was lower than the control group(P <0.05),2 and 3 levels were not statistically significant(P >0.05),renal cortex and medulla Vs value: 1,2,3 levels were lower than the control group(P <0.05),1,2,3 levels of difference was not statistically significant(P >0.05),renal sinus Vs value: 3 level was lower than the control group(P <0.05),there was no statistically significant difference between the other two(P >0.05).(3)There was also a statistically significant difference in the Vs value of the renal in different fundus classification groups(P <0.05),in which renal parenchyma Vs value,or cortical and medulla Vs value: I,II and III levels were lower than those with normal fundus(P <0.05),and the III levels was lower than the I and II levels,there was no statistically significant difference between group I and group II(P >0.05),and renal sinus Vs value: the III level was lower than the normal fundus.there was no statistically significant difference among the other levels(P >0.05).(4)In the observation group,the systolic peak velocity and the end-diastolic velocity of renal interlobar arterial was positively correlated with the renal parenchymal Vs value or cortical and medulla Vs value,and was not correlated with the renal sinus Vs value,and there was no significant correlation between the Vs value of the all parts of renal and the resistance index.(4)Influencing factors: Gender,age,renal side to the renal of different parts Vs value of the effect of no statistically significant(P >0.05);duration of disease and renal parenchyma or cortex,the medulla Vs values were negatively correlated(the r between the course and left renal parenchyma,cortex,medulla Vs value were-0.523,-0.504,and-0.551;the r between the course and the right renal parenchyma,cortex,and medulla Vs value were-0.504,-0.496,-0.523)(p< 0.05),there was no statistically significant correlation between renal sinus Vs value(p>0.05).For the renal volume reduction,the renal parenchyma Vs value was lower than the renal volume normal person,the difference has the statistical significance(p<0.05),the renal cortex,the renal medulla Vs value was lower than the renal volume normal person,the difference does not have the statistical significance(P value slightly >0.05),and between the renal sinus Vs value and the renal volume normal person,there was no statistically significant difference(p>0.05).(5)The clinical common indicators: there was a positive correlation between the PSV,EDV and the renal parenchymal Vs value or cortex and medulla Vs value(the r between the left renal PSV and renal parenchyma,cortex,medulla Vs value were 0.770,0.533,0.512,the r between the left renal EDV and renal parenchyma,cortex,medulla Vs value were 0.404,0.415,0.442;the r between the right renal PSV and renal parenchyma,cortex,medulla Vs value were 0.608,0.504,0.533,the r between the right renal EDV and renal parenchyma,cortex,medulla Vs value were 0.575,0.442,0.512)(p<0.05),and there was no statistically significant correlation with the renal sinus Vs value(p>0.05).There was no statistically significant correlation between the Vs value in the renal regions and resistance index(p>0.05).The biochemical index: SCr,BUN,urine routine protein,microalbuminuria and urine α1-globulin were negatively correlated with the Vs value of the renal(the r between SCr and the left renal parenchyma,cortex,medulla,renal sinus Vs value were-0.746,-0.657,-0.565,-0.363,the r between SCr and the right renal parenchyma,cortex,medulla,renal sinus Vs value were-0.688,-0.659,-0.601,-0.336;the r between BUN and the left renal parenchyma,cortex,medulla,renal sinus Vs value were-0.621,-0.600,-0.534,-0.404,the r between BUN and the right renal parenchyma,cortex,medulla,renal sinus Vs value were and-0.525,-0.591,-0.574,-0.363;the r between urine routine protein and the left renal parenchyma,cortex,medulla,renal sinus Vs value were-0.692,-0.652,-0.508,-0.412,the r between urine routine protein and the right renal parenchyma,cortex,medulla,renal sinus Vs value were-0.680,-0.652,-0.528,-0.305;the r between urine microalbuminuria and left renal parenchyma,cortex,medulla,renal sinus Vs value were-0.802,-0.673,-0.513,-0.465,the r between urine microalbuminuria and right renal parenchyma,cortex,medulla,renal sinus Vs value were-0.800,-0.658,-0.547,-0.413;the r between urine α1-microglobulin and the left renal parenchyma,cortex,medulla,renal sinus Vs value were-0.818,-0.748,-0.690,-0.421,the r between urine α1-microglobulin and the right renal parenchyma,cortex,medulla,renal sinus Vs value were-0.776,-0.746,-0.711,-0.389),positively correlated with GFR(the r between GFR and the left renal parenchyma,cortex,medulla,renal sinus Vs were 0.677,0.555,0.482,0.305,the r between GFR and the right renal parenchyma,cortex,medulla,renal sinus Vs were 0.622,0.553,0.485,0.232),and the correlation was statistically significant(p<0.05).Conclusions:(1)The renal shear wave velocity(Vs value)measured by ARFI-VTQ technique was able to quantitatively measure the elastic value of the renal in hypertensive patients,and the renal Vs value was: renal cortex > Renal medulla > Renal sinus.(2)In patients with hypertension,the renal Vs value was lower than the normal renal,the VS value of renal was related to the degree of hypertension and renal injury,and the Vs value decreases with the aggravation of disease.(3)ARFI-VTQ technology can quantitatively evaluate the early renal injury in hypertensive patients,and provide some diagnostic value and new methods for early renal injury in hypertensive patients. |
PDF Full Text Request