目的：探讨超声造影（Contrast-enhanced ultrasound，CEUS）显像技术诊断糖尿病肾病（DN）的临床价值。方法：选取Mogensen分期为Ⅰ、Ⅱ、Ⅲ、Ⅳ期的2型糖尿病住院患者45例，其中Ⅰ、Ⅱ期为A组，Ⅲ期为B组，Ⅳ期为C组，每组15例，选取10例健康志愿者为对照组（N组）。所有受试者行CEUS检查，并对感兴趣区域行时间-强度曲线（TIC）定量分析。结果：与N组比较，A组曲线下面积（AUC）增大，达峰时间（TTP）、平均渡越时间（MTT）延长，差异有统计学意义（P<0.05），而B组AUC增大、C组AUC减小、B组和C组灌注峰值强度（PI）降低、TTP、MTT延长及C组Grad增大亦然（P<0.05）。且上述TIC曲线定量参数与肾功能生化指标尿白蛋白排泄率（UAE）、肌酐（Cr）、尿素氮（BUN）、尿酸（UA)直线相关。结论：CEUS技术能实时动态反映各期DN肾脏微循环血流灌注的变化，并在一定程度上反映DN肾功能的损害程度。
Abstract
Objective: To investigate the clinical value of contrast-enhanced ultrasound(CEUS) imaging technique in diabetic nephropathy(DN). Methods: Forty-five patients with type 2 diabetes mellitus were divided into group A with DN stages Ⅰ and Ⅱ, group B with DN stage Ⅲ and group C with DN stage Ⅳ. There were fifteen patients in each group. Ten volunteers were enrolled as control group(group N). All subjects underwent CEUS examination, and quantitative analysis was performed on time-intensity curves(TIC) of region of interest. Results: Compared with group N, AUC, TTP, MTT in group A were increased. AUC in group B was increased and in group C was decreased, PI in group B and C were decreased, TTP and MTT were increased, and Grad in group C was increased(All P<0.05). And there were linear correlation between parameters of TIC and indexes of renal function which included UAE, Cr, BUN, UA. Conclusion: CEUS could observe the changes of renal microvascular perfusion of DN in a real-time and dynamic manner, and reflect the extent of the injury of renal function of DN to a certain extent.
关键词
糖尿病肾病 /
超声检查 /
多普勒 /
彩色
Key words
Diabetic nephropathies /
Ultrasonography, Doppler, color
中图分类号：
Ｒ692
Ｒ587.1
Ｒ445.1
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]Fiorentio L, Cavalera M, Menini S, et al. Loss of TIMP3 underlies diabetic nephropathy via FoxO1/STAT1 interplay[J]. EMBO Mol Med, 2013, 5(3): 441-455.
[2]Bhalla V, Velez MG, Chertow GM. A transcriptional blueprint for human and murine diabetic kidney disease[J]. Diabetes, 2013, 62(1): 31-33.
[3]Agarwal R, Duffin KL, Laska D A, et al. A prospective study of multiple protein biomarkers to predict progression in diabetic chronic kidney disease[J]. Nephro Dial Transplant, 2014, 29(12): 2293-2302.
[4]de Boer IH, Rue TC, Hall YN, et al. Temporal trends in the prevalence of diabetic kidney disease in the united states[J]. JAMA, 2011, 305(24): 2532-2539.
[5]Jerums G, Premaratne E, Panagiotopoulos S, et al. New and old markers of progression of diabetic nephropathy[J]. Diabetes Res Clin Pract, 2008, 82(Suppl 1): 30-37.
[6]Lee JH, Kim SS, Kim IJ, et al. Clinical implication of plasma and urine YKL-40, as a proinflammatory biomarker, on early stage of nephropathy in type 2 diabetic patients[J]. J Diabtes Complications, 2012, 26(4): 308-312.
[7]Dai HY, Zheng M, Tang RN, et al. Effects of angiotensin receptor blocker on phenotypic alterations of podocytes in early diabetic nephropathy[J]. Am J Med Sci, 2011, 341(3): 207-214.
[8]Ma F, Cang Y, Zhao B, et al. Contrast-enhanced ultrasound with SonoVue could accurately assess the renal microvascular perfusion in diabetic kidney damage[J]. Nephrol Dial Transplant, 2012, 27(7): 2891-2898.
[9]Mcarthur C, Baxter GM. Current and potential renal applications of contrast-enhanced ultrasound[J]. Clin Radiol, 2012, 67(9): 909-922.
[10]Xu HX. Era of diagnostic and interventional ultrasound[J]. World J Radiol, 2011, 3(5): 141-146.
[11]李明星，罗志建，陈晓梅，等. 超声造影与核素肾动态显像在评价兔肾缺血再灌注损伤中的对比研究[J]. 泸州医学院学报，2011，34（5）：607-611．
[12]Farina R, Pennisi F, La Rosa M, et al． Functional study of the transplanted kidney with power Doppler US and time/intensity curves[J]． Radiol Med, 2007, 112(1): 64-73．
[13]Dong Y, Wang WP, Lin P, et al. Assessment of renal perfusion with contrast-enhanced ultrasound: Preliminary results in early diabetic nephropathies[J]. Clin Hemorheol Microcirc, 2015，62（2016）: 229-238.
[14]Wang L, Wu J, Cheng JF, et al. Diagnostic value of quantitative contrast-enhanced ultrasound for early detection of renal hyperperfusion in diabetic kidney disease[J]. J Nephrol, 2015, 28(6): 669-678.
基金
四川省科技厅与泸州市人民政府、泸州医学院联合科研基金（编号14JC0187）。
