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目的:研究单侧输尿管梗阻解除后肾功能早期恢复的规律,分析多层螺旋CT(MSCT)灌注参数在肾积水肾功能可复性评估中的临床应用价值。方法:建立大白兔右侧输尿管部分梗阻肾积水模型。分对照组、梗阻2周组、梗阻4周组及梗阻8周组,后3组在解除梗阻后饲养4周,各组在梗阻解除前、后均行MSCT灌注扫描、彩色多普勒超声显像(CDFI)及单光子正电子发射计算机体层成像(SPECT)测定,后处死试验动物制成普通病理切片。结果:①各梗阻组的总肾小球滤过率(GFR)均明显低于正常对照组,解除梗阻后,各组总GFR与解除梗阻前无显著性差异;②梗阻2周、4周组及8周组右肾GFR均显著低于正常对照组,梗阻解除后,2周组的右肾GFR有所恢复;③梗阻4周组和8周组在梗阻解除后,其肾动脉的舒张末速度(EDV)显著低于正常对照组,梗阻2周组在梗阻解除后,肾动脉EDV与正常对照组无显著性差异;④梗阻2周组在梗阻解除后,其右肾皮质、髓质的血流量(BF)、血容量(BV)值较梗阻解除前明显上升,接近正常对照组水平,而梗阻4周组、8周组在梗阻解除4周后,其右肾BF、BV则未见明显恢复,明显低于正常对照组;⑤随着梗阻时间的延长,患肾病理学改变愈明显。结论:MSCT灌注成像能够提高积水肾脏形态学和血流灌注的信息,其与CDFI相结合有望成为预测肾功能可复性的金标准。
OBJECTIVE: To study the regularity of early recovery of renal function after unilateral ureteral obstruction, and to evaluate the clinical value of multi-slice spiral CT (MSCT) perfusion parameters in the evaluation of renal function refolding. Methods: The right ureteral obstruction hydronephrosis model was established. The rats in the control group, 2 weeks obstruction group, 4 weeks obstruction group and 8 weeks obstruction group, the latter 3 groups were kept for 4 weeks after obstruction was obstructed. MSCT perfusion scanning was performed before and after the obstruction was relieved in each group, and color Doppler sonography Like (CDFI) and single-photon positron emission computed tomography (SPECT) measurements, post-sacrifice animals were made into normal pathology sections. Results ① The total glomerular filtration rate (GFR) in each obstruction group was significantly lower than that in the normal control group. After the obstruction was removed, there was no significant difference in total GFR and obstruction before obstruction; And GFR of right kidney in 8-week group were significantly lower than those in normal control group. The GFR of right kidney recovered after 2 weeks in obstruction group. ③ After 4 weeks and 8 weeks of obstruction, (EDV) was significantly lower than that of the normal control group. There was no significant difference in the EDV of renal artery between the 2-week obstruction group and the normal control group after obstruction was relieved; Blood flow (BF) and blood volume (BV) increased significantly before the obstruction was relieved, close to the level of the normal control group. In the obstructive 4-week group and the 8-week obstructive group, BF and BV of the right kidneys were not seen after 4 weeks Significantly recovered, significantly lower than the normal control group; ⑤ With the extension of obstruction time, the more obvious pathological changes of renal disease. Conclusion: MSCT perfusion imaging can improve the information of hydronephrosis and blood perfusion. Combined with CDFI, it is expected to be the gold standard for predicting renal refolding.