The Application Research Of Shear Wave Elastography In Staging Of Chronic Kidney Disease And Different Pathological Types

Objective:To explore the application value of SWE in different stages and different pathological types of CKD patients and evaluate whether SWE can become a new method for the early diagnosis and non-invasive monitoring of disease progression of CKD,SWE was applied to observe the changes of the YM of the renal parenchyma inpatients with CKD and healthy people.Methods:220 patients admitted to the department of nephrology of the second Affiliated Hospital of Hebei Medical University,confirmed as CKD and received renal biopsy from January 2018 to December 2018 and 72healthy volunteers for physical examination in the same period as control group were selected.The young modulus of lower pole parenchyma of right renal were detected of each subject by Supersonic Aixplorer type color doppler ultrasound and the same part was measured 5 times.The average value of YM was taken after removing the maximum and the minimum value.At the same time,serum creatinine,urea nitrogen,?₂-microglobulin,and the 24 urinary protein quantitation in CKD patients was detected and recorded.The pathological results of renal biopsy in CKD patients was recorded.The differences of YM among different age groups,gender and body mass index groups in the contol group were compared,the correlations between the YM and clinical biochemical indicators in CKD patients was statistically analyzed,as well as the differences of YM in different stages and different pathological types in CKD patients.Results:1.The YM of parenchyma in the lower pole of right renal showed no significant differences among different age groups,different gender and different body mass index groups in the control group?all P>0.05?.2.The YM of lower pole substance of right renal in chronic kidney disease group was higher than that in normal control group?P<0.05?.3.The YM of parenchyma in the lower pole of right renal in CKD1patients was lower than that in CKD 2-5 patients?all P>0.05?.With the progression of CKD,the YM of right renal lower pole parenchyma gradually increased.4.Serum creatinine,urea nitrogen,and?₂-microglobulin were positively correlated with the YM value of renal renal lower pole parenchyma?all P<0.05?.There was no obvious correlation between the 24 urinary protein quantitation and the YM value of right renal parenchyma in the lower pole?P>0.05?.5.There was statistically significant difference in YM values among different histological types of glomerular disease in CKD patients?P<0.05?.The YM value in patients with primary glomerular diseases and secondary nephropathy was lower than those in patients with tubulointerstitial diseases?all P<0.05?.The YM value of the right renal lower pole substance in patients with different stages of membranous nephropathy was significantly different?P<0.05?.The YM value of parenchyma in the lower pole of right renal in patients with stage?membranous nephropathy were lower than that in the stage?and stage?membranous nephropathy patients?all P<0.05?.However,there was no significance difference in YM value between the stage?and stage?membranous nephropathy?P>0.05?.The YM value of right renal lower pole parenchyma in patients with atpical membranous nephropathy was lower than that of patients with stage?membranous nephropathy?P<0.05?.Conclusion:1.The YM value of renal parenchyma is different between chronic kidney disease group and normal control group.Using SWE to assess renal elasticity can be used to distinguish renal tissues of patients with chronic kidney disease and normal people.2.With the progression of CKD,the YM value of right renal parenchyma in the lower pole gradually increased.The greater the YM,the poorer the renal elasticity and the more serious the renal damage.Using SWE to measure YM of renal parenchyma can provide reference for evaluating renal function and judging CKD staging,and has certain significance for early diagnosis of CKD.3.SWE can provide a new non-invasive examination method for judging the degree of renal fibrosis and monitoring the progression of CKD.