探讨超声造影评价移植肾动脉狭窄（TRAS）患者支架置入术后短期疗效的临床价值。

选取南京大学附属金陵医院（东部战区总医院）2011年1月至2020年12月收治的25例TRAS行支架置入术的患者，所有患者均为行球囊扩张术后再次狭窄而行肾动脉支架置入术者。术后24 h行超声造影检查，应用时间-强度曲线（TIC）分析获得移植肾皮质血流灌注曲线下面积（AUC），并根据AUC将患者分为灌注不良组（AUC≤865 dB·s；9例）和灌注良好组（AUC＞865 dB·s；16例）。采用独立样本t检验或χ²检验分析比较2组患者的年龄、性别、病程、狭窄部位、狭窄程度等临床特征，支架置入术治疗前后血压、肾功能、TIC参数（开始增强时间、达峰强度、达峰时间），以及术后发生短期肾功能恶化比例的差异。

与灌注良好组比较，灌注不良组患者球囊扩张术后发生再次狭窄时间更短［（3.5±2.1）个月 vs（4.8±1.6）个月］、肾动脉狭窄程度更重［（85.4±8.6）% vs（80.1±7.9）%］、狭窄长度更长［（15.5±7.4）mm vs（13.5±6.3）mm］，差异具有统计学意义（t=3.457、5.452、7.746，P=0.049、0.035、0.021）；支架置入术后，与灌注良好组患者相比，灌注不良组患者血肌酐值浓度更高［（325.6±115.3）μmol/L vs（212.5±103.4）μmol/L］和估算的肾小球滤过率更低［（61.8±11.7）ml/（min·1.73 m²）vs（72.5±12.4）ml/（min·1.73 m²）］，肾皮质血流灌注峰值强度更低［（28.8±8.6）dB vs（33.4±10.3）dB］，达峰时间更长［（24.6±7.9）s vs（20.9±6.7）s］，差异均具有统计学意义（t=5.735、5.343、6.125、7.950，P=0.019、0.026、0.020、0.009）。术后随访时间为（10.5±1.6）个月，灌注不良组发生移植肾功能恶化的比例高于灌注良好组（12.0% vs 4.0%），差异具有统计学意义（χ²=5.297，P=0.021）。

超声造影可通过评估肾皮质血流灌注情况评价TRAS支架置入术后的短期疗效，其TIC参数峰值强度更低、达峰时间更长可作为TRAS行支架置入术后移植肾皮质血流灌注不良的依据，且可预测患者短期内发生移植肾功能恶化的可能性增加，可为筛选适合进行介入治疗的患者提供影像学参考依据。

To evaluate the clinical value of contrast-enhanced ultrasound (CEUS) in evaluating the short-term outcome of stent implantation for transplant renal artery stenosis (TRAS).

A total of 25 TRAS patients with stent implantation were admitted to Jinling Hospital affiliated to Nanjing University (Eastern Theater Command General Hospital) from January 2011 to December 2020. CEUS was performed 24 h after the surgery, and the time-intensity curve (TIC) was analyzed to obtain the area under curve (AUC). All patients were divided into either a poorly-perfused group (AUC≤865 dB·s; 9 cases) or a well-perfused group (AUC＞865 dB·s; 16 cases) according to the AUC. Clinical data including age, gender, course of disease, site and degree of stenosis, blood pressure, renal function, and TIC parameters (arrival time, peak intensity, and time to peak), and postoperative renal function deterioration were compared using the independent sample t test or χ² test.

Compared with the well-perfused group, the poorly perfused group had shorter course of stenosis after balloon dilation [(3.5±2.1) months vs (4.8±1.6) months], the degree of renal artery stenosis was more severe [(85.4±8.6)% vs (80.1±7.9)%], and the stenosis was longer [(15.5±7.4) mm vs (13.5±6.3) mm]; the differences were statistically significant (t=3.457, 5.452, and 7.746; P=0.049, 0.035, and 0.021, respectively). After stent implantation, compared with the well-perfused group, serum creatinine in the poorly perfused group was higher [(325.6±115.3) μmol/L vs (212.5±103.4) μmol/L] and estimated glomerular filtration rate was lower [(61.8±11.7) ml/(min·1.73 m²) vs (72.5±12.4) ml/(min·1.73 m²)], while cortical peak intensity was weaker [(28.8±8.6) dB vs (33.4±10.3) dB] and time to peak was longer [(24.6±7.9) s vs (20.9±6.7) s]; the differences were statistically significant (t=5.735, 5.343, 6.125, and 7.950; P=0.019, 0.026, 0.020, and 0.009, respectively). The mean follow-up time was 10.5±1.6 months, and the proportion of patients in the poorly perfused group was significantly higher than that in the well-perfused group (12.0% vs 4.0%, χ²=5.297, P=0.021).

CEUS can be used to evaluate the short-term outcome of TRAS stent implantation by evaluating renal cortical blood perfusion. Lower peak intensity and longer time to peak on CEUS can predict poor cortical blood perfusion of the transplanted kidney and increased possibility of short-term transplant renal function deterioration after stent implantation in TRAS patients, thus providing a reference for screening patients suitable for interventional therapy.