彩色多普勒超声技术评价高压氧辅助治疗糖尿病肾病疗效的研究  

Therapeutic effect assessment of hyperbaric oxygen in treating diabetic kidney disease by color Doppler ultrasonography

作　　者：张靓[1] 王燕[4] 万金娥[2] 马瑞霞[3] 杨雪[1] 于宁[1] Zhang Liang;Wang Yan;Wan Jin’e;Ma Ruixia;Yang Xue;Yu Ning(Department of Abdominal Ultrasound,The Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院腹部超声科,山东省青岛266000 [2]青岛大学附属医院高压氧科,山东省青岛266000 [3]青岛大学附属医院肾病科,山东省青岛266000 [4]青岛市市立医院西院区物理诊断科

出　　处：《中华航海医学与高气压医学杂志》2021年第6期784-787,共4页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

摘　　要：目的研究彩色多普勒超声技术对高压氧(hyperbric oxygen,HBO)治疗糖尿病肾病(diabetic kidney disease,DKD)患者疗效的评价。方法选取2019年10月至2020年10月在青岛大学附属医院确诊为DKD患者64例,按照随机数字表法将患者分为对照组和HBO治疗组,每组32例。对照组采取综合治疗(常规降糖、降压,低脂、低盐、低糖饮食,加强运动),HBO组在对照组的基础上行HBO治疗。治疗前后对所有患者行彩色多普勒检查;记录患者肾脏血流动力学指标,包括收缩期峰值流速(peak systolic velocity,PSV)、舒张末期流速(end diastolic velocity,EDV)、血管阻力指数(resistance index,RI)、血管搏动指数(pulsatility index,PI)。治疗后对2组患者进行疗效评价,绘制RI、PI、EDV、PSV关于疗效的受试者工作特性(ROC)曲线,分析其对HBO治疗DKD疗效的评价。结果治疗后,对照组与HBO组24 h尿白蛋白排泄率(urinary albumin excretion rate,UAER)、血尿素氮(blood urea nitrogen,BUN)、EDV、PSV、RI、PI较治疗前均改善,HBO组各指标较对照组改善更为明显,差异均有统计学意义(P<0.05)。治疗后总有效率HBO组(96.88%)明显高于对照组(75.00%),差异有统计学意义(P<0.05)。经计算得出RI、PI、EDV用于判断DKD疗效具有一定价值,且RI的ROC曲线下的面积为0.866,截断值为0.76,敏感度为72.73%、特异度为91.38%。结论HBO辅助治疗对DKD有较好的疗效,超声具有无创实时优势,可以将RI监测作为DKD治疗评价指标;RI截断点为0.76时,对DKD治疗效果有一定评判价值。Objective To discuss the assessment value of color Doppler ultrasonography on patients with diabetic kidney disease(DKD)treated by hyperbaric oxygen(HBO)therapy.Methods A total of 64 DKD patients confirmed in the Affiliated Hospital of Qingdao University from October 2019 to October 2020 were divided into control group(n=32)and HBO group(n=32)using the random number table.The control group was given comprehensive treatments(conventional hypoglycemic and antihypertensive treatment,low-fat,low-salt,and low-sugar diet,and physical exercise),and the HBO group was given HBO based on the treatment in the control group.Color Doppler ultrasound examination was performed on each patient before and after treatment,and renal hemodynamic indicators such as peak systolic velocity(PSV),end diastolic velocity(EDV),resistance index(RI),and pulsatility index(PI)were recorded.After treatment,receiver operating characteristic(ROC)curves related to therapeutic effect were made based on the indicators of RI,PI,EDV,and PSV.Results After treatment,the 24-hour urinary albumin excretion rate(UAER),blood urea nitrogen(BUN),EDV,PSV,RI,and PI in the control group and the HBO group were all improved compared with those before treatment,and all the above indicators in HBO group had greater improvement than those in the control group,with a statistically significant differences(P<0.05).After treatment,the total effective rate of the HBO group(96.88%)was higher than that of the control group(75.01%),with a statistically significant difference(P<0.05).According to the calculation,RI,PI,and EDV had some value for evaluating the efficacy of HBO on DKD patients,specifically,when the area under ROC of RI was 0.866,the cutoff value was 0.76,the sensitivity was 72.73%,and the specificity was 91.38%.Conclusion The comprehensive treatments combined with HBO have a good effect on DKD.With the non-invasive and real-time advantages,color Doppler ultrasound can be adopted to monitor RI for assessing the efficacy of DKD treatment.When the RI cutoff value rea

关 键 词：彩色多普勒 高压氧 糖尿病肾病 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]