| Objectives By measuring renal blood flow parameters, glomerular filtration rate,thickness of renal parenchyma and renal size in patients with moderately or severe renal hydronephrosis and normal kidney controls, analysis of hydronephrosis above measure differences between patients and controls, and comparied above index between patients with seeper kidney have functions or no;Using ROC curve method to compare the significance of Color Doppler Flow imaging and nuclide nephro-dynamic imaging on functional evaluation of the kidney with moderate or severe renal hydronephrosis.Methods A total of 57 patients with moderate or severe obstructive hydronephrosis in the first hospital of Shijiazhuang diagnosed by ultrasound examination during June 2014 and June 2015. Choose 60 the same hospital health check-up crowd cases, there is no history of kidney disease and renal function is normal as control group. Application of Philips IU-22 high-end color doppler ultrasonic diagnostic instrument, uwb probe, probe frequency from 2.0 to 5.0 MHz. Conventional measurement indexes including renal parenchyma thickness(RPT), anteroposterior diameter(APD), maximum length to diameter(LD) and transverse diameter(TD), water accumulating volume were calculated by the automatic instrument with software system. Computer automatically record the peak systolic velocity(PSV), end-diastolic velocity(EDV). Blood flow resistance index(RI) of calculation basis Norris formula: RI =(PSV, EDV)/PSV. The Discovery VH layer model of single photon emission computer camera was matched with VPC-35 lowenergy high resolution collimator(American GE) renal dynamic imaging. Input in the syringe imaging agent of radioactive count and the patient's height and weight, calculate the bilateral renal glomerular filtration rate(GRF) and renal GRF. According to the method of Gates handler is measured with renal GRF< 10 ml/min diagnosed with no function. Patients by Color Doppler Flow imaging and nuclide renal dynamic imaging examination, 2 ~ 5 days for renal puncture drainage, continuous recording after three days of daily average. The diagnosis of renal functional gold standard for unilateral kidney > 200 ml/24 h. Using SPSS13.0 statistical analysis. Measurement data using mean±standard deviation, the blood perfusion parameters(PSV, EDV and RI) and glomerular filtration rate(GRF) and renal morphology parameters(renal cortical thickness and renal size) comparison between different degree of hydronephrosis group and the control group using analysis of variance and nonparametric test, the comparison between the patients have renal function and not in RI, GRF and morphological parameters using the two independent samples t test, blood perfusion parameters and GRF comparison in Cases of hydronephrosis and not using matching t test. Count data using percentage, diagnosis and the result of the gold standard in comparative analysis of the application of matching the?2 test. Patients with different degree of hydronephrosis kidney renal parenchyma thickness and RI value using bivariate correlation analysis, Pearson correlation coefficient reflects the connection strength. Color Doppler Flow imaging and nuclide renal dynamic imaging assessment of renal function using ROC curve method, according to the area under the ROC curve and the optimum parameters of the cutoff value corresponding evaluation two methods to evaluate the value of renal function. With P <0.05 for the difference was statistically significant.Results 1 Compared hydronephrosis kidney in case group with normal group of renal blood flow parameters of PSV and EDV value as the degree of hydronephrosis increase presents the tendency of decrease, and the blood flow resistance index(RI) values with the increase of the degree of hydronephrosis showed a trend of rising, RI values of control group, moderate hydronephrosis group and severe hydronephrosis group respectively(0.62±0.07),(0.75±0.10) and(0.83±0.10), the significant difference between groups(P < 0.05). RI values of renal patients with hydronephrotic kidney(0.77±0.13) is significantly higher than the normal kindey(0.58±0.10)(P<0.05). Renal parenchyma thickness of control group, moderate hydronephrosis group and severe hydronephrosis group respectively(2.31±0.25)cm ?(1.24±0.23)cm and(0.41±0.19)cm, the renal parenchyma thickness with the increase of the degree of hydronephrosis showed the tendency of decrease(P<0.05). Renal volume of control group, moderate hydronephrosis group and severe hydronephrosis group respectively(124.8±32.74) cm3,(128.3±39.22)cm3 and(223.5±43.81) cm3, the renal volume with the increase of the degree of hydronephrosis showed the tendency of increase(P<0.05). Glomerular filtration rate of control group, moderate hydronephrosis group and severe hydronephrosis group respectively 56.61 Ml/min, 33.24 Ml/min and 15.39 Ml/min, the glomerular filtration rate with the increase of the degree of hydronephrosis showed the tendency of decrease(P<0.05).2 Renal parenchyma thickness and RI value exists significant negative correlation(r =-0.829) in hydronephrosis renal, statistically significant correlation(P<0.05).3 Moderate hydronephrosis group of functional kidney and not were 19 cases and 6 cases respectively, in patients with severe hydronephrosis group kidney active almighty and has no function of 8 cases and 24 cases respectively, two groups of patients with renal function has obvious difference(?2 =14.643, P<0.05). The functional group of renal blood flow parameters of PSV and EDV value were(42.29±12.68) and(11.23±5.92)respectively, were higher than no renal function group, RI in renal functional group value of(0.75±0.11) below the no renal function group(P<0.05). Renal parenchyma thickness in renal functional and no functional group of patients were(1.04±0.32) cm and(0.47±0.28) cm respectively, and significantly lower than the normal control group(P<0.05), renal volume, respectively were(149.7±41.68) cm3 and(265.8±38.39) cm3 respectively, significantly greater than normal control group(P < 0.05). GRF in renal functional group value was(28.42±12.50) Ml/min higher than the no renal function group(P<0.05).4 The area under ROC curve of RI and GRF in the diagnosis of renal function was significantly larger than the standard reference curve. The area under the curve of RI and GRF evaluation and the 95% credible period were 0.924(0.854, 0.994) and 0.902(0.823, 0.982). The best cutoff value of RI diagnosis of renal function based on ROC curve was <0.81, and corresponding sensitivity,specificity,positive predictive value,negative predictive value, accuracy were 0.889, 0.933, 0.923, 0.903 and 0.912. There was no significant difference in the evaluation of renal function and the gold standard of the two diagnostic methods(P>0.05).Conclusions With the increase of degree of hydronephrosis, renal blood flow resistance increased and reduced glomerular filtration rate. With reduction in hydronephrosis renal function, increasing renal blood flow resistance and decreasing glomerular filtration rate.Application of Color Doppler Flow imaging measurement RI diagnosis of renal function the best cutoff value is > 0.81. For the patients with moderate or severe renal hydrocephalus, using the Color Doppler ultrasound to evaluate the renal function were economic and accurate rate, and it could be used as an important reference index for noninvasive diagnosis of renal function. |
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