功能磁共振成像在评估肾移植术后移植肾功能中的价值

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摘要目的：探讨功能磁共振成像（magnetic resonance imaging,MRI）评估肾移植术后移植肾功能的价值。方法：选择2018年1月至2019年12月于南京医科大学第一附属医院接受肾移植手术且移植肾功能稳定的52例患者为研究对象，采用99mTc-DTPA的清除率作为参考肾小球滤过率（reference glomerular filtration rate,rGFR），使用动态增强（dynamic contrast-enhanced，DCE）-MRI估测其移植肾GFR并进行比较。使用偏倚、精度、相关性、一致性和诊断分析，将DCE-MRI估测结果与rGFR进行比较。分别构建4组大鼠模型：同种同体肾移植组（SYN组）、肾脏缺血再灌注组（IRI组）、T细胞介导的排斥反应组（TCMR组）和抗体介导的排斥反应组（ABMR组）。术后7 d行扩散加权成像（diffusion weighted imaging,DWI）序列扫描测量其表观扩散系数（apparent diffusion coefficient,ADC），检查结束后立即处死大鼠，获取移植肾组织行组织学检查。结果： DCE-MRI估测的GFR与rGFR呈显著正相关（r=0.71，P<0.01），一致性分析显示偏倚为-3.544 mL/(min·1.73 m2)，精度为15.33 mL/(min·1.73 m2)，95%CI为6007 mL/(min·1.73 m2)，DCE-MRI在诊断慢性肾脏病（CKD）3期及以上［GFR<60 mL/(min·1.73 m2)］的患者时，曲线下面积为0.91，灵敏度为79.17%，特异度为82.14%。进一步动物实验发现4组间肾脏髓质ADC值均无显著差异，SYN组与IRI组肾脏皮质ADC值无显著差异，TCMR组及ABMR组皮质ADC值较SYN组均显著降低（P<0.05），而TCMR组与ABMR组相比无显著差异。急性排斥组（TCMR组和ABMR组）皮质和髓质ADC值较SYN组、IRI组均显著降低（P均<0.05）。结论：功能MRI可有效且安全地无创评估肾移植术后患者的移植肾功能，具有较高的灵敏度及特异度；动物实验发现功能MRI可用于诊断肾移植术后急性排斥反应。

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	倪斌1
	郑明2
	王珂3
	张俊麒1
	张玉东4
	韩志坚2
	陶俊2
	居小兵2
	谭若芸2
	顾民1
	2
	王子杰2

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Abstract： Objective： To investigate the value of functional magnetic resonance imaging (MRI) in evaluating the status of kidney grafts after renal transplantation. Methods： A total of 52 patients with stable renal function who underwent renal transplantation in the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2019 were selected as the study objects. The clearance rate of 99mTc DTPA was used as the reference glomerular filtration rate (rGFR), and the GFR of kidney grafts was estimated by dynamic contrast-enhanced （DCE）-MRI. The estimated DCE-MRI results were compared with rGFR using bias, accuracy, correlation, consistency and diagnostic analysis. Four groups of rat models were established: syngeneic graft group (SYN), renal ischemiareperfusion injury group (IRI), T cell mediated rejection group (TCMR) and antibody mediated rejection group (ABMR). The apparent diffusion coefficient (ADC) was measured by DWI sequence scanning on the 7th day after operation. After the examination, all rats were sacrificed immediately, and the transplanted kidney tissues were harvested for histological examination. Results： There was a significant positive correlation between the estimated GFR by DCE-MRI and rGFR (r=0.71, P<0.01). The consistency analysis showed that the bias was -3.544 mL/(min·1.73 m2), the accuracy was 15.33 mL/(min·1.73 m2), and the 95% confidence interval was 60.07 mL/(min·1.73 m2). DCE-MRI had an area under the curve of 0.91 with sensitivity of 79.17% and specificity of 82.14% in the diagnosis of patients with CKD stage 3 and above ［GFR<60 mL/(min·1.73 m2)］. Further animal experiments showed that there was no statistical difference in renal medulla ADC values between the four groups. In the meantime, renal cortex ADC values in SYN and IRI exhibit no significant difference. It′s worth noting that the cortical ADC values in TCMR group and ABMR group were significantly lower than those in SYN group (P<0.05), while there was no significant difference between TCMR group and ABMR group. In addition, the acute rejection group (TCMR group and ABMR group) had significantly lower renal cortical and medullary ADC values than those in the SYN group and IRI group (both P<0.05). Conclusion： Functional MRI could effectively and safely evaluate the renal function of patients after renal transplantation, with high sensitivity and specificity. In animal experiments, acute rejection after kidney transplantation can be well diagnosed by functional MRI.

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收稿日期: 2023-01-06

基金资助: 国家自然科学基金资助项目(81900684)；江苏省自然科学基金青年基金资助项目(BK20191063)

通讯作者: 顾民（通讯作者），教授，主任医师，博士生导师，E—mail： lancetgu@aliyun.com；王子杰（通讯作者），主治医师，E-mail：wangzijie@njmu.edu.cn

作者简介: 倪斌（1995—），男，博士研究生

引用本文:

倪斌1，郑明2，王珂3，张俊麒1，张玉东4，韩志坚2，陶俊2，居小兵2，谭若芸2，顾民1,2，王子杰2. 功能磁共振成像在评估肾移植术后移植肾功能中的价值[J]. 江苏大学学报:医学版, 2024, 34(02): 93-98. NI Bin1, ZHENG Ming2, WANG Ke3, ZHANG Junqi1, ZHANG Yudong4, HAN Zhijian2, TAO Jun2, JU Xiaobing2, TAN Ruoyun2, GU Min1,2, WANG Zijie2. Evaluation of renal function after renal transplantation by functional magnetic resonance imaging. Journal of Jiangsu University(Medicine Edition), 2024, 34(02): 93-98.

链接本文:

http://zzs.ujs.edu.cn/xbyxb/CN/ 或 http://zzs.ujs.edu.cn/xbyxb/CN/Y2024/V34/I02/93

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