磁共振扩散峰度成像定量评估IgA肾病早期肾小管间质损害的应用价值研究  

The application value of magnetic resonance diffusion kurtosis imaging in quantitative assessment of early tubulointerstitial damage in IgA nephropathy

作　　者：林家珍 崔凤[1] 殷佳珍[1] 乐先杰[1] 曹佑军[1] 杨丙奎 LIN Jia-zhen;CUI Feng;YIN Jia-zhen;LE Xian-jie;CAO You-jun;YANG Bing-kui(Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou 310007,China)

机构地区：[1]浙江中医药大学附属杭州市中医院,杭州浙江310007

出　　处：《中国临床医学影像杂志》2022年第9期663-668,共6页Journal of China Clinic Medical Imaging

基　　金：浙江省自然科学基金资助项目(LGF18H180010)。

摘　　要：目的:研究3.0T磁共振扩散峰度成像(DKI)定量评估IgA肾病(IgAN)患者早期肾小管间质损害及肾功能的临床应用价值。方法:本研究共纳入经肾穿刺活检诊断的IgAN患者研究组31例和健康志愿者对照组18例。依据肾小管间质损伤病理积分标准将研究组IgAN患者分为2组:轻度损害组15例和中重度损害组16例。所有参与者均接受常规肾功能检查及双肾MRI检查,获得肾实质的DKI参数值:MD和MK值。采用单因素方差分析(ANOVA)比较3组(研究组2组、对照组1组)间肾脏MD和MK值的差异,采用Spearman相关性分析肾脏MD和MK值与肾功能指标和肾小管间质损伤病理积分的相关性,应用ROC曲线评估肾脏MD和MK值对IgAN不同程度肾小管间质损害的鉴别诊断效能。结果:肾皮质MD和MK值在对照组和2组不同程度肾小管间质损害受试者间差异有统计学意义(P<0.05),皮质MD值从大到小依次为对照组、轻度损害组、中重度损害组;皮质MK值从小到大依次为对照组、轻度损害组、中重度损害组;肾皮质MD和MK值与肾小球滤过率(eGFR)、血肌酐(Scr)、胱抑素C(Cys-C)及肾小管间质损伤病理积分均相关(0.4<r<0.6);皮质MD和MK值鉴别对照组与轻度损害组,ROC曲线下面积(AUC)分别为0.748和0.752,鉴别轻度损害组与中重度损害组,ROC AUC分别为0.719和0.729。结论:磁共振DKI可无创性定量评估IgAN早期肾小管间质损害程度,MD和MK值可作为早期预测IgAN肾小管间质病理损害程度变化的重要指标,有较好的临床应用价值。Objective:To study the clinical application value of 3.0T magnetic resonance diffusion kurtosis imaging(DKI)in quantitative assessment of early tubulointerstitial damage and renal function in patients with IgA nephropathy(IgAN).Methods:A total of 31 patients diagnosed with IgAN by renal biopsy were enrolled in the study group and 18 healthy volunteers were enrolled in the control group.The patients with IgAN were divided into two groups according to the renal tubulointerstitial injury scoring standard,15 cases were included in the mild injury group and 16 cases were included in the moderate-severe injury group.All participants underwent routine renal function tests and MRI,the renal parenchymal DKI parameter values of MD and MK were obtained.ANOVA was used to compare the differences of parenchymal MD and MK values among the three groups,the Spearman correlation coefficient was calculated to assess the relationship between renal MD,MK values and the functional indexes as well as tubulointerstitial injury score.The ROC curve was used to evaluate the diagnostic efficacy of renal MD and MK values in differentiating IgAN patients with different degrees of renal tubulointerstitial damage.Results:The differences of renal cortical MD and MK values among the control group and the two groups of subjects with different degrees of renal tubulointerstitial damage were statistically significant(P<0.05).The trend of cortical MD values was:control group>mild injury group>moderate-severe injury group.The trend of cortical MK values was:control group<mild injury group<moderate-severe injury group.Cortical MD and MK values were corelated with eGFR,Scr,Cys-C and tubulointerstitial injury score(0.4<r<0.6).The areas under the ROC curve of cortical MD and MK values were 0.748 and 0.752 respectively when diferentiating the control group from the mild injury group.When diferentiating the mild injury group from the moderate-severe injury group,the areas under the ROC curve of cortical MD and MK values were 0.719 and 0.729,respectively.Con

关 键 词：肾小球肾炎 IGA 磁共振成像 

分 类 号：R692.31[医药卫生—泌尿科学] R445.2[医药卫生—外科学]