弹性模量值诊断早期原发性肾病综合征的价值及其与肾功能指标的相关性

  目的  探讨剪切波弹性成像弹性模量值在早期原发性肾病综合征（PNS）患者与健康者对比研究及肾功能判定指标相关性中的应用价值。  方法  选取经临床及病理证实且符合早期PNS慢性肾病1期，即肾功能正常（血尿素氮及血肌酐指标正常）阶段的病例30例，分析检测PNS患者双肾弹性模量值特征，另取30例健康者双侧肾脏作为对照组，分析两组肾弹性模量值的差异及PNS组双肾弹性模量平均值（E_mean）与24 h尿蛋白量和血清β2-微球蛋白量的相关性。  结果  PNS组与对照组双侧肾脏长度、厚度、肾皮质组间比较，差异无统计学意义（P > 0.05）。PNS组双肾弹性模量平均值（E_mean）、最大值（E_max）、最小值（E_min）、弥散度均高于对照组（P < 0.05）。E_max=22.45 kPa时，鉴别诊断两组的敏感度、特异性、准确率分别为80.0%、93.3%、86.7%，曲线下面积最大（0.857），诊断效能最高。PNS组E_mean与24 h尿蛋白量和血清β2-微球蛋白量呈正相关，与血尿素氮和血肌酐无相关性。  结论  剪切波弹性成像弹性模量值量化分析技术为无创性判断早期PNS肾脏硬度变化及损伤程度提供病理基础及分子影像学依据，为早期PNS的诊断与鉴别提供可靠依据，亦可联合24 h尿蛋白量和血清β2-微球蛋白量对早期PNS肾功能损伤作出有价值的评估。 

Application value of elastic modulus in diagnosis of early primary nephrotic syndrome and its correlation with renal function indexes

  Objective  To investigate the application value of shear wave elastography elastic modulus value in the comparative study between patients with early primary nephrotic syndrome (PNS) and healthy subjects and the correlation of renal function indicators.  Methods  Patients with early PNS CKD stage1 Patients with normal renal function (blood urea nitrogen and serum creatinine) in normal stage] confirmed by clinical and pathological examination were involved. The characteristics of renal elastic modulus values in 30 PNS patients were analyzed, and the bilateral kidneys of 30 healthy subjects were selected as the control group. The difference of renal elastic modulus values between the two groups and the correlation between the mean renal elastic modulus (E_mean) in the PNS group and the 24-hour urinary protein volume and serum β2-microglobulin volume (β2-MG) were analyzed.  Results  There was no significant difference of renal length, thickness and renal cortex of bilateral kidneys between PNS group and control group (P > 0.05). The mean elastic modulus (E_mean), maximum value (E_max), minimum value (E_min) and dispersion of PNS group were higher than those of control group (P < 0.05). When the maximum elastic modulus was 22.45 kPa, the sensitivity, specificity and accuracy of the two groups were 80.0%, 93.3% and 86.7%, respectively. The area under the curve was the largest (0.857), the diagnostic efficiency was the highest. In PNS group, E_mean was positively correlated with 24-hour urinary protein volume and serum β2-microglobulin volume, but there was no correlation with blood urea nitrogen and serum creatinine.  Conclusion  The quantitative analysis technique of shear wave elastography elastic modulus value can provide pathological basis and molecular imaging basis for noninvasive determination of the changes of renal hardness and the degree of injury in early PNS, and provide reliable basis for diagnosis and differentiation of early PNS. It can provide valuable assessment of renal function injury in early PNS by combining 24-hour urinary protein volume and serum β2-microglobulin volume.