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目的:探讨声辐射力脉冲成像(ARFI)技术与尿β2-微球蛋白(β2-MG)检测联合诊断高尿酸肾病(HUAN)的临床价值。方法:回顾性分析和比较192例原发性高尿酸血症患者(PHUA组)、162例HUAN患者(HUAN组)和360例健康体检者(对照组)的血尿酸(UA)、血尿素氮(BUN)、血肌酐(Cr)及尿β2-MG水平、二维超声检测结果及ARFI技术检测的肾皮质、髓质和肾窦SWV值,分析HUAN患者的SWV值与临床分期的相关性,其肾实质、肾窦SWV值与尿β2-MG水平的相关性。结果:162例HUAN患者中,肾实质回声增强76例(46.91%),肾窦增宽89例(54.94%),肾皮质髓质结石49例(30.25%);192例PHUA患者和360例健康体检者肾皮质和髓质回声均无明显异常,肾窦结石分别为3例(0.83%)和5例(2.60%)。HUAN组肾皮质、髓质和肾窦SWV值分别为3.32±0.45 m/s、3.02±0.51 m/s和1.58±0.45 m/s;PHUA组分别为2.92±0.64 m/s、2.51±0.51 m/s和1.41±0.35 m/s;对照组分别为2.73±0.58 m/s、2.26±0.43 m/s和1.21±0.21 m/s;三组SWV值均为肾皮质>肾髓质>肾窦(P<0.05)。HUAN组尿β2-MG水平明显高于PHUA组和对照组(P<0.05)。HUAN组尿β2-MG水平与肾实质SWV值呈线性正相关(r=0.442,P<0.001),而与肾窦呈零相关性(r=0)。Ⅰ、Ⅱ、Ⅲ期HUAN患者肾皮质SWV值比较无明显差异(P>0.05),Ⅱ-Ⅴ期肾髓质、肾窦SWV值均高于Ⅰ期(P<0.05);Ⅳ、Ⅴ期肾皮质SWV值高于Ⅲ期(P<0.001)。结论:HUAN患者在BUN和Cr升高之前,ARFI技术的SWV值和尿β2-MG水平均显著升高。ARFI技术联合尿β2-MG检测可作为评估肾实质组织弹性硬度及诊断早期HUAN的重要方法。
Objective: To investigate the clinical value of combined diagnostic angiography (ARFI) with urinary β2-microglobulin (β2-MG) in the diagnosis of hyperuricemic nephropathy (HUAN). Methods: A total of 192 patients with primary hyperuricemia (PHUA group), 162 patients with HUAN (HUAN group) and 360 healthy subjects (control group) were retrospectively analyzed. The levels of blood uric acid (UA), blood urea nitrogen (BUN), serum creatinine (Cr) and urinary β2-MG levels, two-dimensional ultrasound and ARFI detection of renal cortex, medulla and renal sinus SWV value analysis of HUAN patients SWV value and clinical stage correlation, The renal parenchyma, SWV and urinary β2-MG levels of the correlation. RESULTS: Among 162 HUAN patients, 76 cases (46.91%) had enhancement of renal parenchyma, 89 cases (54.94%) had renal sinus enlargement, and 49 cases (30.25%) had renal medullary calculi. 192 PHUA patients and 360 healthy subjects Renal cortex and medullary echoes were not abnormal, calculi in renal sinus were 3 cases (0.83%) and 5 cases (2.60%). The SWV values of renal cortex, medulla and renal sinus in HUAN group were 3.32 ± 0.45 m / s, 3.02 ± 0.51 m / s and 1.58 ± 0.45 m / s respectively, while those in PHUA group were 2.92 ± 0.64 m / s and 2.51 ± 0.51 m / s and 1.41 ± 0.35 m / s in the control group, 2.73 ± 0.58 m / s in the control group, 2.26 ± 0.43 m / s in the control group, and 1.21 ± 0.21 m / s in the control group (P <0.05). The urinary β2-MG level in HUAN group was significantly higher than that in PHUA group and control group (P <0.05). The urinary β2-MG level in HUAN group was positively correlated with the SWV of renal parenchyma (r = 0.442, P <0.001), but not with renal sinus (r = 0). There was no significant difference in the SWV of renal cortex between stage Ⅰ, Ⅱ, and Ⅲ HUAN patients (P> 0.05). The SWV of renal medulla and renal sinus in stage Ⅱ-V were higher than that of stage Ⅰ (P <0.05) Cortical SWV was higher than in stage III (P <0.001). CONCLUSIONS: The SWV and urinary β2-MG levels of ARFI increased significantly in patients with HUAN before BUN and Cr were elevated. ARFI combined with urine β2-MG test can be used as an assessment of renal parenchymal elastic stiffness and diagnosis of early HUAN an important method.