基于弹性成像提示早期糖尿病肾病风险的列线图模型初探  

A preliminary study on the nomogram model based on elastography to evaluate the risk of diabetic kidney disease

作　　者：谢永林 李君 彭咏 田世宏 XIE Yonglin;LI Jun;PENG Yong;TIAN Shihong(Department of Ultrasound, Guangzhou Integrated Traditional Chinese and Western Medicine Hospital, Guangzhou 510800, China;Department of Endocrinology, Union Shenzhen Hospital (Nanshan Hospital), Shenzhen 518000, China)

机构地区：[1]广东省广州市中西医结合医院超声科,广东广州510800 [2]华中科技大学协和深圳医院(南山医院)内分泌科,广东深圳518000

出　　处：《医学影像学杂志》2022年第6期990-993,997,共5页Journal of Medical Imaging

基　　金：广东省深圳市南山区卫生科技计划项目(编号:2016042)。

摘　　要：目的利用列线图探索基于剪切波弹性成像(SWE)的早期糖尿病肾病(DKD)筛查方案。方法选取早期DKD患者52例(早期DKD组),普通糖尿病患者50例(对照组)。记录两组患者的临床资料、实验室指标和肾脏杨氏模量(Young’s modulus,YM)(肾皮质YM、肾髓质YM、肾窦YM)。采用多因素Logistic回归分析糖尿病发展为早期DKD的风险指标。建立列线图评价潜在指标预测早期DKD的价值。结果多因素Logistic回归分析显示,尿白蛋白排泄率(UAER)、胱抑素C(CysC)、糖化血红蛋白(HbA1C)以及肾皮质YM是糖尿病发展为早期DKD的独立风险指标(P<0.05)。基于UAER、CysC、HbA1C以及肾皮质YM建立的用于提示患者罹患早期DKD风险的列线图,具有良好的辨别力(C-index 0.81)和校准度(χ^(2)=10.247,P=0.283,Hosmer-Lemeshow检验)。结论SWE联合UAER、CysC及HbA1C绘制的列线图有助于早期评估患者罹患DKD的风险。Objective To explore a screening method for early diabetic kidney disease(DKD)using a nomogram model based on shear wave elastography(SWE).Methods A total of 52 patients with early DKD(early DKD group)and 50 patients with normal diabetes(control group)were included in this study.The clinical data,laboratory indexes and Young’s modulus(YM)of kidney(renal cortex YM,renal medulla YM,renal sinus YM)in the two groups were recorded.The risk factors of diabetes developing into early DKD were analyzed by multivariate Logistic analyses.A nomogram was built to evaluate the potential indicators in predicting early DKD.Results Multivariate Logistic regression analysis showed that urinary albumin excretion rate(UAER),cystatin C(CysC),glycosylated hemoglobin(HbA1C),and renal cortex YM were independent risk indicators for the development of early DKD from diabetes(P<0.05).Based on UAER,CysC,HbA1C,and renal cortex YM,the nomogram was established to indicate the risk of early DKD,which had good discrimination(C-index 0.81)and calibration(χ^(2)=10.247,P=0.283,Hosmer-Lemeshow test).Conclusion The nomogram established by SWE combined with UAER,CysC and HbA1C is helpful for early assessment of the risk of early DKD.

关 键 词：糖尿病肾病 尿白蛋白排泄率 血清胱抑素-C 糖化血红蛋白 列线图剪切波弹性成像 超声检查 

分 类 号：R587.1[医药卫生—内分泌] R445.1[医药卫生—内科学]