应用血氧水平依赖功能MRI评价早期糖尿病肾脏病肾脏氧耗变化的价值  

Effect of renal oxygen consumption on early diabetic nephropathy measured by blood oxygen level-dependent functional magnetic resonance imaging

作　　者：段敏 王雪莹 赵红亮 王燕磊 郑卓肇[3] 曹沉香 赵文惠[2] 肖建中[2] Duan Min;Wang Xueying;Zhao Hongliang;Wang Yanlei;Zheng Zhuozhao;Cao Chenxiang;Zhao Wenhui;Xiao Jianzhong(Department of Emergency,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China;Department of Endocrinology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China;Department of Radiology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院,清华大学临床医学院急诊科,102218 [2]清华大学附属北京清华长庚医院,清华大学临床医学院内分泌与代谢科,102218 [3]清华大学附属北京清华长庚医院,清华大学临床医学院放射诊断科,102218

出　　处：《中华糖尿病杂志》2021年第10期984-990,共7页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：北京市科技计划(D171100002817003);清华大学精准医学科研计划(12020B7041)。

摘　　要：目的探讨应用血氧水平依赖功能MRI(BOLD-MRI)评价2型糖尿病(T2DM)患者早期糖尿病肾脏病(DKD)肾脏氧耗变化的价值。方法选取2017年7月至2019年12月在清华大学附属北京清华长庚医院就诊的58例T2DM患者,并招募30名健康志愿者(健康受试组)。根据受试者尿白蛋白/肌酐比值(UACR)及估算的肾小球滤过率(eGFR)将T2DM患者分为2组,T2DM肾功能正常组30例,为UACR<30 mg/g且eGFR≥90 ml·min^(-1)·(1.73 m^(2))^(-1)的T2DM患者;T2DM微量白蛋白尿组28例,为30 mg/g≤UACR≤300 mg/g且eGFR>60 ml·min^(-1)·(1.73 m^(2))^(-1)的T2DM患者。所有受试者均行BOLD-MRI和动脉自旋标记功能磁共振成像(ASL-MRI)检查,对受试者肾脏皮质、髓质氧合R_(2)^(*)值及血液灌流量肾血流量(RBF)进行定量分析并采用单因素方差分析或χ^(2)检验比较。采用Pearson线性相关分析评价肾皮质、髓质氧合R_(2)^(*)值与eGRF相关性,采用使用受试者工作特征(ROC)曲线分析肾脏髓质氧合R_(2)^(*)值诊断T2DM患者早期DKD的效能。结果三组受试者的肾皮、髓质氧合R_(2)^(*)值差异有统计学意义(P<0.01),与健康受试组比较,T2DM肾功能正常组患者肾髓质R_(2)^(*)值升高具有统计学差异(P=0.011)。T2DM患者肾髓质R_(2)^(*)值与eGRF呈负相关(r=-0.323,P=0.001)。肾脏髓质氧合R_(2)^(*)值诊断T2DM患者DKD的曲线下面积为0.837,有中等诊断效能。结论T2DM患者较健康志愿者肾脏皮、髓质氧耗明显增加,应用BOLD-MRI监测肾髓质R_(2)^(*)值升高预测早期DKD具有一定价值。Objective In this study,blood oxygen level-dependent functional magnetic resonance imaging(BOLD-MRI)was used to observe the difference between renal oxygen consumption with or without diabetic nephropathy,and to explore a non-invasive,reliable,and sensitive examination method for the assessment and diagnosis of early diabetic kidney disease(DKD).Methods A total of 58 type 2 diabetes(T2DM)subjects who admitted in Beijing Tsinghua Changgung Hospital from July 2017 to December 2019 were selected,and 30 normal subjects were recruited.According to the urine albumin/creatinine ratio(UACR)and the assessment of glomerular filtration rate(eGFR),patients with T2DM were divided into two groups:normal renal function group(n=30):UACR<30 mg/g and eGFR≥90 ml·min^(-1)·(1.73 m^(-2))^(-1);microalbuminuria group(n=28):UACR 30 to 300 mg/g and eGFR>60 ml·min^(-1)·(1.73 m^(-2))^(-1).The renal functional MRI(BOLD-MRI and arterial spin labeling-MRI)were performed to obtain quantitative values of the subjects′renal cortex,and medulla oxygenation as well as blood perfusion.The results were analyzed by variance,χ^(2)test,Pearson linear correlation analysis and receiver operating characteristic(ROC)curve.Furosemide was used in the normal controls to evaluate the reliability of BOLD-MRI scaning.Results The renal cortex and medulla oxygenation values of three groups subjects were statistically different(P<0.01).Compared with control group,the medulla oxygenation R_(2)^(*)values were elevated in patients with microalbuminuria(P=0.011).The medulla oxygenation R_(2)^(*)values and eGFR were negatively correlated(r=-0.323,P=0.001).The area under the ROC curve of diagnosis of DKD by medulla oxygenation R_(2)^(*)value was 0.837.Conclusions The oxygen consumption of kidney cortex and medulla in T2DM patients was significantly increased.The renal medulla demonstrated a hypoxic injury in the diabetes patients without microalbuminuria and impaired renal function.Therefore,BOLD-MRI could be used to monitor the increase of renal medulla R_(2)^(*)

关 键 词：糖尿病 2型 磁共振成像 糖尿病肾脏病 肾髓质缺氧 

分 类 号：R445.2[医药卫生—影像医学与核医学] R587.2[医药卫生—诊断学] R692.9[医药卫生—临床医学]