分析声触诊弹性成像（STE）联合脉冲多普勒（PW）超声成像参数与早期慢性肾病（CKD）改变及其分期的相关性，探讨2种超声成像参数对CKD早期预测、发现及分期诊断的临床意义。

收集2022年9月至2023年4月川北医学院附属医院收治的按肾小球滤过率分期为1~3期的CKD患者共82例作为病例组，将病例组分成CKD 1期、CKD 2期、CKD 3期3组，另选择同期健康体检者35名作为对照组，病例组和对照组分别进行PW、STE检查并记录相关参数，PW参数包括肾门处肾动脉（MRA）、肾窦部段动脉（SRA）、肾锥体叶间动脉（IRA）的收缩期血液峰值流速（PSV）、舒张末期流速（EDV）以及血流阻力指数（RI），STE参数包括肾皮质杨氏模量值的最大值（Emax）、平均值（Emean）、最小值（Emin）。比较病例组与对照组之间超声参数的差异，通过二元Logistic回归分析诊断早期CKD的影响因素，绘制受试者操作特征（ROC）曲线，评估发现早期CKD改变有统计学意义的参数指标以及这些参数对早期CKD联合诊断的价值；分析4组间各个超声参数指标的差异，运用多分类Logistic回归分析，计算各组超声参数的异常检出率，评估对早期CKD分期的诊断价值。

Logistic回归分析显示，MRA-PSV、MRA-EDV、Emean、Emax对预测早期CKD差异具有统计学意义（OR=0.952、0.893、1.687、1.416，P=0.001、=0.002、=0.001、<0.001），其中Emax是诊断早期CKD的独立影响因素，截断值为11.01 kPa。在单因素诊断中，Emax对早期CKD诊断的ROC曲线下面积（AUC）最大（AUC=0.740）；上述4项指标联合诊断的AUC=0.792，高于各个单项参数。4组间对比提示，MRA-PSV、MRA-EDV对CKD 2期检出率最高，且MRA-EDV检出率高于MRA-PSV（55.6% vs 51.9%）；SRA-PSV、SRA-EDV、Emax对CKD 3期检出率最高（60.9% vs 52.2% vs 43.5%），其中SRA-PSV检出率最高；Emean对CKD 1期检出率最高（37.5%）；联合诊断方式在早期CKD分期中显著提高了CKD 1期的检出率（50.0%）。

MRA-PSV、MRA-EDV、Emean、Emax可作为预测可能发生早期CKD的超声诊断参数，且对早期CKD初步分期具有一定的诊断价值，PW联合STE提高了早期CKD检出及分期的诊断效能，PW联合STE有望成为早期CKD发现、分期、评估及随访的有效影像学检查方式。

To analyze the correlation of parameters of sound touch elastography (STE) combined with pulsed wave (PW) Doppler imaging with early changes and stage of chronic kidney disease (CKD), and to explore the clinical significance of the parameters of the two ultrasound imaging modalities for early prediction, detection, and staging of chronic kidney disease.

Eighty-two patients with stages 1-3 CKD classified by glomerular filtration rate from September 2022 to April 2023 at the Affiliated Hospital of North Sichuan Medical College were collected as cases. These cases were divided into three groups according to CKD stage: CKD stage 1, CKD stage 2, and CKD stage 3. Thirty-five healthy individuals in the same period were selected as controls. Both the case group and control group underwent PW and STE examinations to record relevant parameters. PW parameters included peak systolic blood flow velocity (PSV), end diastolic blood flow velocity (EDV), and blood flow resistance index (RI) of the renal artery at the renal hilum (MRA), the renal sinus segmental artery (SRA), and the renal pyramidal interlobular artery (IRA). STE parameters included the maximum (Emax), average (Emean), and minimum (Emin) values of the renal cortex Young's modulus. The differences in these parameters were compared between the case group and the control group, and binary logistic regression analysis was performed to identify the parameters that had statistical significance for detecting early chronic kidney disease changes, and receiver operating characteristic (ROC) curve analysis was performed to assess the value of these parameters for the diagnosis of early chronic kidney disease. The differences in ultrasound parameters were compared among the four groups, multi-class logistic regression analysis was performed to calculate the abnormal detection rate by ultrasound parameters in each group, and their diagnostic value for early CKD staging was evaluated.

Compared with the control group, the differences in MRA-PSV, MRA-EDV, Emean, and Emax in predicting early CKD in the case group were statistically significant (odds ratio=0.952, 0.893, 1.687, and 1.416; P=0.001, =0.002, =0.001, and <0.001, respectively). Emax was an independent factor for the diagnosis of early CKD, with a cutoff value of 11.01 kPa. In univariate diagnosis, Max had the largest area under the ROC curve (AUC=0.740) for the diagnosis of early CKD. The AUC of joint diagnosis (0.792) was higher than that of each individual parameter. The comparison between the four groups indicated that MRA-PSV and MRA-EDV had the highest detection rate for CKD stage 2, and the detection rate by MRA-EDV was higher than that by MRA-PSV (55.6% vs 51.9%). SRA-PSV, SRA-EDV, and Emax had the highest detection rate for CKD stage 3 (60.9% vs 52.2% vs 43.5%), with SRA-PSV having the highest detection rate. Emean had the highest detection rate for CKD stage 1 (37.5%). The joint diagnosis significantly improved the detection rate of CKD stage 1 (50.0%) in early CKD staging.

MRA-PSV, MRA-EDV, Emean, and Emax can be used as ultrasound diagnostic parameters to predict the possible occurrence of early CKD, and have appreciated diagnostic value for the initial staging of early CKD. PW combined with STE improves the diagnostic performance of early CKD detection and staging. PW combined with STE is expected to become a reliable and effective imaging examination method for early CKD detection, staging, evaluation, and follow-up.