扩散张量成像对早期糖尿病肾病肾脏异常灌注及弥散水平评价价值  

The value of diffusion tensor imaging in detecting abnormalities in renal perfusion and renal diffusion in early-stage diabetic nephropathy

作　　者：朱敏 李世星 刘子航 李洪义 邢健 张黎 孙继平 宋先东 ZHU Min;LI Shixing;LIU Zihang;LI Hongyi;XING Jian;ZHANG Li;SUN Jiping;SONG Xiandong(Imaging Department,Hongqi Hospital Affiliated to Mudanjiang Medical College,Mudanjiang 157011,China;Mudanjiang Medical College,Mudanjiang 157011,China;Office of Research Services,Hongqi Hospital Affiliated to Mudanjiang Medical College,Mudanjiang 157011,China;Imaging Department,Hangzhou Cancer Hospital,Hangzhou 310002,China;The 3rd Department of Orthopedic Surgery,Hongqi Hospital Affiliated to Mudanjiang Medical College,Mudanjiang 157011,China)

机构地区：[1]牡丹江医学院附属红旗医院影像科,黑龙江牡丹江157011 [2]牡丹江医学院,黑龙江牡丹江157011 [3]牡丹江医学院附属红旗医院科研科,黑龙江牡丹江157011 [4]杭州市肿瘤医院影像科,浙江杭州310002 [5]牡丹江医学院附属红旗医院骨外三科,黑龙江牡丹江157011

出　　处：《中国现代医生》2020年第11期122-126,共5页China Modern Doctor

基　　金：黑龙江省省属高等学校基本科研业务费科研项目(2017-KYYWFMY-0667)。

摘　　要：目的探讨扩散张量成像对早期糖尿病肾病肾脏异常灌注及弥散水平评价价值。方法选取2017年2月~2019年2月我院收治的104例早期糖尿病肾病患者,依据是否含微量白蛋白,分为早期糖尿病肾病组(40例)和糖尿病组(64例),另选取同期来我院接受体检的40例健康人群作为对照组,分别对以上三组进行MRI扫描,获取IVIM参数,分析三组临床资料、体素内不相干运动成像相关参数、扩张量成像有关参数,对比肾脏髓质FA值及皮髓质f、D值对糖尿病及糖尿病肾病诊断价值。结果三组年龄、BMI差别没有明显差别(P>0.05),糖尿病组eGFR及空腹血糖均高于对照组(P<0.05);糖尿病肾病组空腹血糖高于对照组,eGFR低于糖尿病组(P<0.05);三组肾皮质D、灌溉分数值均高于髓质,D*值低于髓质。糖尿病肾病组皮髓质灌溉分数、D值低于对照组和糖尿病组,三组存在明显差别(P<0.05);三组肾皮质FA值低于髓质(P<0.05),糖尿病肾病组和对照组肾皮质γ1低于髓质(P<0.05),三组皮质γ3、ADC、γ2值高于髓质(P<0.05)。糖尿病肾病组和糖尿病组γ1皮、髓质、ADC、γ2值没有明显区别(P>0.05)。糖尿病组肾髓质FA值低于对照组,糖尿病组及糖尿病肾病组髓质γ3值均高于对照组(P<0.05);对糖尿病及糖尿病肾病鉴别,皮质f值诊断效能最好,敏感度和特异度均高于肾皮质D、肾髓质D、肾髓质f、肾髓质FA(P<0.05)。结论糖尿病肾病弥散变化和早期肾脏灌注及通过弥散水平评价可通过扩散张量成像反映,在早期糖尿病肾病患者肾功能异常评价中发挥重要作用。Objective To investigate the value of diffusion tensor imaging(DTI)in detecting abnormalities in renal perfusion and renal diffusion in early-stage diabetic nephropathy(DN).Methods In this study,104 patients with early-stage DN admitted in our hospital from February 2017 to February 2019 were selected.They were divided into the DN group(n=40)and the diabetes group(n=64)depending on whether they presented a positive result of a urine microalbumin test.Another 40 healthy individuals receiving physical examinations were selected as healthy controls group.All subjects underwent magnetic resonance imaging(MRI)scan.Their intravoxel incoherent motion(IVIM)parameters were collected,and clinical characteristics,IVIM parameters and diffusion coefficients were analyzed.Diagnostic values of fractional anisotropy(FA)for renal cortex and medulla,f and D values for the medulla for distinguishing DN from diabetes mellitus(DM)were compared.Results Nonsignificant differences in age and body mass index(BMI)were shown among the three groups(P>0.05).The diabetes group presented a higher estimated glomerular filtration rate(eGFR)and a higher fasting blood-glucose(FBG)level than the control group(P<0.05).The DN group showed a higher FBG level than the control group and a lower eGFR than the diabetes group(P<0.05).In the three groups,D and f values for the cortex were higher than those for the medulla,while the D*value for the cortex was lower than that for the medulla.The f and D values for both the cortex and medulla in the DN group were lower than those in the control group and diabetes group,with significant differences among the three groups(P<0.05).In the three groups,FA values for the cortex were lower than those for the medulla(P<0.05).In the DN group and control group,γ1 values for the cortex were lower than those for the medulla(P<0.05).Corticalγ3,apparent diffusion coefficient(ADC)andγ2 values in the three groups were higher than medullary ones(P<0.05).There were nonsignificant differences inγ1,ADC andγ2 for both the cor

关 键 词：早期糖尿病肾病 肾脏异常 灌注水平 弥散水平 扩散张量成像 

分 类 号：R587.2[医药卫生—内分泌]