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目的探讨慢性马兜铃酸肾病(CAAN)患者的肾脏B超特征及其对判断肾脏病变慢性化程度的意义。方法回顾性分析124例临床确诊为CAAN的患者资料,对其肾脏B超特点以及与肾功能损害之间关系进行分析,并对其中经肾活检确诊的19例CAAN患者与18例非感染性、非AAN的慢性肾小管间质肾病(nAAN-CTIN)患者进行比较。结果CAAN患者的肾脏B超特征主要表现为肾实质厚度变薄(90．3％)、肾脏萎缩(62．9％)和双肾不等大(17．74％);其肾脏长径、体积及实质厚度分别与Scr、eGFR、肾小管功能评分明显相关(P值均<0．05)。19例CAAN与18例nAAN-CTIN患者的比较显示,在两组年龄、性别、病程以及肾功能损害程度无明显差异的情况下,CAAN组肾小管细胞脱落和肾小球缺血皱缩更为严重,而肾间质细胞浸润相对较少(P<0．05)。与nAAN-CTIN组比较,CAAN组患者的肾脏B超体积缩小及实质厚度变薄更为显著(P<0．05),但肾脏B超各项指标与肾脏病理指标的变化未见明显相关性。结论CAAN患者具有肾脏萎缩、肾实质变薄以及双肾不等大的B超特征,与其它原因CTIN的不同特点在于其肾脏萎缩更为显著,尤其以肾脏实质变薄出现较早。CAAN患者肾脏B超检查与肾脏病理变化的相关性尚不肯定,但应可以辅助肾功能损害程度的判断以及CAAN的疾病诊断。
Objective To investigate the characteristics of renal B-ultrasound in patients with chronic aristolochic acid nephropathy (CAAN) and its significance in judging the degree of chronic renal disease. Methods A retrospective analysis of 124 cases of clinically diagnosed patients with CAAN, B-renal characteristics of its renal characteristics and the relationship between renal damage, and which were diagnosed by renal biopsy in 19 patients with CAAN and 18 cases of non-infectious, Patients with non-AAN chronic tubulointerstitial nephropathy (nAAN-CTIN) were compared. Results The renal B ultrasound features of CAAN patients were mainly as follows: thinning of renal parenchyma (90.3%), atrophy of kidney (62.9%) and unequal size of kidney (17.74%); And real thickness were significantly correlated with Scr, eGFR and renal tubular function scores (P <0.05). The comparison between 19 CAAN patients and 18 nAAN-CTIN patients showed that in the two groups of age, gender, duration of disease and the degree of renal dysfunction no significant difference between the CAAN group tubular cell loss and glomerular ischemia shrink more Severe, while the infiltration of renal interstitial cells is relatively small (P <0.05). Compared with nAAN-CTIN group, the renal B-volume and the thinned thickness of CAAN group were more significant (P <0.05), but there was no significant correlation between B-ultrasound index and renal pathological changes . Conclusion CAAN patients with renal atrophy, thinning of the renal parenchyma and unequal bilateral B-ultrasound features, and other causes of CTIN is characterized by a more significant renal atrophy, especially with the thinning of the kidney appeared earlier. The correlation between renal B ultrasound examination and renal pathological changes in patients with CAAN is uncertain, but it should be able to help determine the extent of renal damage and diagnosis of CAAN.