Quantitative Evaluation In IgA Nephropathy Patients With Dynamic Sonographic Tissue Perfusion Measurement

Research Background:IgAnephropathy is one of the most common primary glomerulonephritis types, also it’s one of the main reasons why the end-stage renal failure (ESRD) occurs.Because its onset conceal,clinical and pathological changes is complicated, and it’s clinical and pathologic stage is not consistent, all those bring serious difficulties to clinical diagnosis and treatment. Investigating the curative effect and prognosis factors’ identification method becomes the clinical medicine difficult and hot. Besides glomerular and tubulo-interstitium pathological changes,renal vascular lesions in IgA nephropathy plays a more and more important role. And it becomes one of the most important reference prognosis indexes.There are many methods such as renal biopsy, renal angiography, MRI and CT perfusion imaging, etc.which can evaluate renal vascular lesions.Among them renal biopsy is the most reliable one.Due to the limit of the subjective and objective conditions, these methods are not considered as a routine method for monitoring IgAN vascular lesions progress.And repeated live kidney biopsy on people is more unsuitable.The non-invasive diagnosis DTPM obviously not only overcomes shortcomings with those technology,such as injury and unrepeatability,but can quantitatively analyze. From hemodynamic changes,it researches renal cortical blood perfusion,reflects severity of vascular lesions. In recent years,it attracts much attention at home and abroad.Purpose:DTPM (Dynamic sonographic Tissue Perfusion Measurement with color doppler ultrasound) analyzes the cortex blood perfusion, this paper discusses the feasibility of this technology monitoring IgA nephropathy renal interstitial vascular lesions progress and its clinical significance.Subjects and Methods:158hospital patients during2012-Feb. and2012-Feb. who confirmed by pathology as primary IgAN in renal medicine of the2nd Xiangya Hospital (accord with primary glomerular disease classification standard of WHO in1995),getting rid of systemic lupus erythematosus (sle),anaphylatic purpura nephritis,diabetic nephropathy and other secondary nephritis,and acute IgAN.According to the kidney interstitial vascular impairment severity,the cases are divided into four groups with reference to Katafuchi’s semiquantitative integral method, they are no vascular lesions group, mild vascular lesions group, moderate vascular lesions group and severe vascular lesions group.DTPM:Use GE Vivid7color doppler ultrasound diagnostic instrument to collect2-3cardiac cycle color doppler video images of the patients to be diagnosed as IgAN,Three days before the biopsy.The researcher collects the patients’ clinical and pathological material after pathological diagnosis of IgAN.Select and copy their renals’ color dynamic images in the DICOM format to your computer equipped PixelFlux software on for offline analysis.Measure each group’s the DTPM technology perfusion parameters:Vmix、Imix and TRI,then analyze statistically.Results:1.Comparison between groups of clinical indexes:The course of the light, medium and heavy are longer than no-vascular lesions group, the differences are statistically significant;Blood pressure(include SBP and DBP) and age of the light, medium, heavy group are higher(or older) than the non-vascular.lesions group, and severe vascular lesions group, are higher(or older) than mild vascular lesions groups, the differences are statistically significant.2.Comparison between groups of DTPM technology parameters:(1) Comparison with no-vascular lesions group:in mild vascular lesions group,Imix、Vmix value are a bit low, the difference are not statistically significant (P>0.05),TRI heighten, the difference are statistically significant (P<0.05); in medium and severe group,Vmix、Imix decrease, and TRI increase, differences are statistically significant(P<0.05).(2) Compared with mild vascular lesions group, medium and severe group’s Imix and Vmix reduce, TRI heighten, the differences are statistically significant (P<0.05).(3) Compared with moderate vascular lesions group, Vmix and Imix of severe group reduce, TRI of them heighten, the differences are statistically significant (P<0.05).3.Correlation analysis between DTPM technology perfusion parameters and IGA renal vasculopathy serious degree:Imix、Vmix are negatively related to the IgAN vascular lesions severity grade, TRI and vascular lesions severity degree are positively related.4. ROC curves analysis:sensitivity and specificity of quantitatively evaluation IgAN renal vasculopathy according to TRI、Imix and Vmix are good.Conclusion:1.Correlation. between DTPM perfusion parameters and IGA renal vasculopathy serious degree show that DTPM perfusion parameters can reflect IgA renal vascular lesions well, and they can be used as a set of observation indexes monitoring renal vasculopathy progress.2.With the increase of the IgAN vascular lesions severity,DTPM technology parameters Vmix and Imix reduce,and TRI increase.3. ROC curves analysis indicate:sensitivity and specificity of quantitatively evaluation IgAN renal vasculopathy severity with DTPM technology perfusion parameters TRI、Imix and Vmix are good.