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Color Doppler Estimation of Intrarenal Doppler Indices in Dogs with Renal Disease
|關鍵字:||彩色都卜勒超音波;duplex Doppler ultrasonography;血流阻力指數;血流脈衝指數;收縮-舒張比;腎臟疾病;resistive index (RI);pulsative index (PI);systolic-to-diastolic flow velocities ratio (S/D ratio);renal diseases||出版社:||獸醫學系||摘要:||
人類醫學利用都卜勒超音波偵測腎臟內血流阻力的技術已被應用於協助臨床腎臟疾病的診斷與預後。包括腎臟移植後的急性排斥反應(acute reject)、輸尿管阻塞、急性腎衰竭、慢性腎衰竭等。寵物臨床醫學中，犬貓個體小、呼吸快且無法以語言溝通，故使用超音波操作不易，因此相關文獻少。本實驗以彩色都卜勒超音波偵測32例(46個腎臟)依臨床症狀及臨床病理檢查判定為腎臟疾病的門診病例及13例(22個腎臟)健康之成年犬隻的都卜勒係數，包括血流阻力指數(Resistive index; RI)、血流脈衝指數(Pulsatility index; PI)及收縮-舒張比(S/D ratio; S/D)。結果發現健康成犬左右兩腎的三個平均都卜勒係數並無統計學上的差異，而臨床診斷為急性腎衰竭、慢性腎衰竭及先天性腎發育不良的三個平均都卜勒係數均增加，且與健康犬隻的都卜勒係數有極顯著差異(p<0.01)。急性腎衰竭中，除了腎前性腎病外，腎因性（p<0.01）及腎後性腎病（p<0.05）的三個都卜勒係數皆升高且與健康成犬有統計學差異。此三個都卜勒係數和臨床病理之腎臟指數並無統計學之正相關，但卻與貧血狀況有直接關係。急性腎衰竭中，預後不良病例的三個平均都卜勒係數會高於預後良好的患犬，且兩者之間有統計學上的差異（p<0.05）。由於小動物沒有RI的標準值，故以人類的標準值RI大於0.7為異常之閥值下，以RI值評估腎臟疾病之敏感度為67.39%，特異性為86.36%。本實驗結果認為都卜勒超音波亦可應用於小動物之腎臟疾病，包括區別急性腎衰竭中的腎前性、腎因性及腎後性腎衰竭及評估急性腎衰竭患犬的預後，且相信若再增加病例數並結合病理相關研究，必定具有腎臟疾病的鑑別診斷及評估預後的價值。
In human beings, intrarenal blood flow impedance, obtained by duplex Doppler ultrasonography, has been used to aid in the diagnosis and prognosis of renal diseases such as acute ejection after renal transplant, obstructive uropathy, acute renal failure, and chronic renal failure . This study was planned to evaluate renal vascular resistance by means of color Doppler ultrasonnography in 13 normal dogs and 32 dogs with renal disease. Doppler indices of renal vascular resistance, included resistive index (RI), pulsative index (PI), and systolic-to-diastolic flow velocities ratio (S/D ratio), were determined on interlobal arteries. The Doppler indices of each kidney were compared to clinical laboratory parameters, clinical diagnoses, sonographic findings, and prognosis. No appreciable difference between right and left kidney, mean, intrerenal RI, PI and S/D ratio has been noted in normal dogs. RI, PI and S/D ratio were found to be increased in dogs with renal disease as compared to healthy controls (p<0.01). An elevation in the mean renal RI, PI and S/D ratio was found for the clinical diagnoses of acute renal failure, chronic renal failure, and congenital dysplasia. An elevation of the RI, PI and S/D ratio was also found in association with intrinsic renal disease and post-renal disease. No statistically significant differences were noted between the values for dogs with pre-renal disease versus healthy controls. A direct association was found between anemia and elevated RI, PI and S/D ratio, but there was no correlation between increased RI, PI and S/D ratio with increased creatinine levels. The dogs that die of acute renal failure had a significant ( p<0.05) higher RI, PI and S/D ratio than the dogs recovering from acute renal failure).When the RI greater than 0.7 was considered abnormal, the sensitivity and specificity of the RI in determining normal vs abnormal kidneys were 67.39% and 86.36% respectively. We concluded that the ability of color Doppler ultrasonography to evaluate intrarenal blood flow impedance in the veterinary clinical setting could also contribute to the diagnosis and prognosis of renal disease.
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