血氧水平依赖磁共振成像评估2型糖尿病患者早期肾缺氧改变  

Value of blood oxygen level-dependent magnetic resonance imaging in evaluating the early renal hypoxic changes in patients with type 2 diabetes mellitus

作　　者：任俊杰[1] 李春霞 徐东红[2] 苏卫东[3] 吴彩兰[4] 宋春青[2] 邱丽君[3] 纪盛章[1] 

机构地区：[1]天津市第四中心医院放射科,300140 [2]天津市第四中心医院内分泌科,300140 [3]天津市第四中心医院检验科,300140 [4]天津市第四中心医院核医学科,300140 [5]内蒙古自治区人民医院影像科

出　　处：《中华糖尿病杂志》2017年第3期174-178,共5页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：天津市卫计委科技基金面上项目（2015KY07）

摘　　要：目的探讨血氧水平依赖磁共振成像（BOLD-MRI）在评价2型糖尿病（T2DM）患者肾脏氧合状态及其肾功能的价值。方法采用Philips 3.0T磁共振扫描仪于2014年4月至2015年10月对18例T2DM患者和22名健康志愿者进行肾脏BOLD-MRI扫描。分别测量2组肾脏皮质、髓质的表观自旋-自旋弛豫率（R2^＊）值，并做组内、组间比较。采用Pearson相关性分析方法分析T2DM患者肾脏皮、髓质R2^＊值与由血清胱抑素C（CysC）计算所得的肾小球滤过率（CysC-GFR）的相关性。结果健康对照组、T2DM患者组肾脏髓质R2^＊值均高于皮质，差异具有统计学意义（t=21.5、21.1，均P〈0.01）。T2DM患者组与健康对照组皮质R2^＊值分别为（15.3±1.9）和（15.0±1.7）1/s，差异无统计学意义（t=0.7，P〉0.05），髓质R2^＊值分别为（38.1±4.1）和（29.6±2.7）1/s，组间差异有统计学意义（t=8.0，P〈0.01）。髓质R2^＊在鉴别T2DM患者与健康对照时具有较高的敏感性（83.33%）及特异性（100%），受试者工作特征曲线下面积为0.965，最佳诊断阈值为34.1 1/s。T2DM患者髓质R2^＊值与CysC-GFR呈正相关（r=0.7，P〈0.01），而皮质R2^＊值与CysC-GFR无明显相关性（r=0.1，P〉0.05）。结论BOLD-MRI能够早期发现T2DM患者肾脏髓质缺氧，在一定程度上，髓质R2^＊值的改变可反映肾功能变化。ObjectiveTo evaluate the value of blood oxygen level-dependent magnetic resonance imaging （BOLD-MRI） in the assessment of renal oxygenation of patients with type 2 diabetes mellitus （T2DM）.MethodsFrom April 2014 to October 2015, kidney scans were conducted in eighteen patients with T2DM and twenty-two healthy controls with a Philips 3.0T scanner by using a BOLD-MRI sequence. The medullary and cortical apparent relaxation rate（R2＊）values were measured in both groups. Paired samples t-test and independent samples t-test were used in data comparison within or between groups. The correlation between the renal glomerular filtration rate estimated using cystatin C（CysC-GFR） and the R2^＊ values was analyzed by Pearson correlation coefficient analysis.ResultsThe medullary R2^＊ values were significantly higher than those of cortex in both groups （t=21.5, 21.1, both P〈0.01）. The cortex R2＊ values in patients with T2DM and healthy controls were （15.3±1.9） and （15.0±1.7） 1/s respectively, and there was no significant differences between two groups （t=0.7, P〉0.05）. The medullary R2＊ values in the patients with T2DM and healthy controls were （38.1±4.1） and （29.6±2.7） 1/s respectively, it was significantly higher in the type 2 diabetic patients than that in healthy controls （t=8.0, P〈0.01）. Medullary R2^＊ value had a high sensitivity （83.33%） and specificity （100%） in identifying patients with T2DM with an area under the receiver operating characteristic curve of 0.965, and the best testing threshold was 34.1 1/s. The medullary R2^＊ value was found positively correlated with CysC-GFR level in patients with T2DM （r=0.7, P〈0.01）, but no correlation was found between the cortical R2^＊ value and CysC-GFR （r=0.1, P〉0.05）.ConclusionBOLD-MRI can detect and assess the renal medullary hypoxia in patients with T2DM at the early stage, and medullary R2^＊ value may reflect the changes of renal function.

关 键 词：糖尿病 2型 肾功能 血氧水平依赖磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学]