联合应用血氧水平依赖及动脉自旋标记MRI评估2型糖尿病早期肾功能改变  

Evaluation of early renal function changes in patients with type 2 diabetes mellitus using BOLD and ASL

作　　者：马亚杰 张玉玲 张钰玲[1] 李蓓 季倩[3] Ma Yajie;Zhang Yuling;Zhang Yuling;Li Bei;Ji Qian(The First Central Clinical School,Tianjin Medical University,Tianjin 300070,China;Department of Radiology,Gaoling District Hospital of Traditional Chinese Medicine,Xi'an 710200,China;Department of Radiology,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津医科大学一中心临床学院,天津300070 [2]西安市高陵区中医医院放射科,西安710200 [3]天津市第一中心医院放射科,天津300192

出　　处：《中华放射学杂志》2023年第9期984-989,共6页Chinese Journal of Radiology

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-041A);天津市自然科学基金(21JCYBJC01050)。

摘　　要：目的探讨联合应用血氧水平依赖(BOLD)及动脉自旋标记(ASL)MRI无创评估2型糖尿病(T2DM)患者早期肾功能改变的价值。方法前瞻性收集2019年9月至2022年5月天津市第一中心医院63例T2DM患者,同期收集30例健康志愿者(对照组)。将T2DM患者根据尿白蛋白/肌酐比值(ACR)分为正常白蛋白尿(NAU,ACR<30 mg/g)组和微量白蛋白尿(MAU,30 mg/g≤ACR≤300 mg/g)组,分别为35、28例。所有受试者行腹部BOLD及ASL检查,测量肾皮、髓质表观弛豫率(R2*)及肾皮质肾血流量(RBF)。采用单因素方差分析比较3组间R2*和RBF的差异。应用受试者操作特征曲线分析相关参数鉴别各组的诊断效能,曲线下面积(AUC)的比较采用Z检验。结果对照组、NAU组、MAU组间肾髓质R2*及肾皮质RBF差异有统计学意义(F=45.83、34.15,P<0.001),肾皮质R2*差异无统计学意义(F=2.98,P=0.056)。区分对照组与NAU组时,肾髓质R2*、肾皮质RBF以及两者联合参数的AUC分别为0.921(95%CI 0.827~0.973)、0.704(95%CI 0.578~0.811)、0.964(95%CI 0.885~0.994),联合参数的AUC与肾皮质RBF差异有统计学意义(Z=4.07,P<0.001),与肾髓质R2*差异无统计学意义(Z=1.57,P=0.117);区分NAU组与MAU组时,AUC分别为0.898(95%CI 0.796~0.960)、0.919(95%CI 0.823~0.973)、0.985(95%CI 0.881~0.994),联合参数的AUC与肾髓质R2*、肾皮质RBF间差异有统计学意义(Z=2.39,P=0.017;Z=2.20,P=0.028)。结论BOLD联合ASL能够无创、定量评估T2DM患者早期肾脏氧合水平及血流量变化特点,肾髓质R2*联合肾皮质RBF对糖尿病早期肾功能改变的诊断效能优于单一指标。ObjectiveTo noninvasively evaluate the clinical value of early renal function changes in patients with type 2 diabetes mellitus(T2DM)using blood oxygenation level dependent(BOLD)and arterial spin labeling(ASL)MRI.MethodsA total of 63 T2DM patients from Tianjin First Central Hospital from September 2019 to May 2022 were prospectively collected,30 healthy volunteers(control group)were collected during the same period.According to albumin creatinine ratio(ACR),patients with T2DM were divided into normal albuminuria(NAU,ACR<30 mg/g)group and microalbuminuria(MAU,30 mg/g≤ACR≤300 mg/g)group,there were 35 and 28 cases respectively.All subjects underwent abdominal BOLD and ASL scans.The values of renal cortical and medullary apparent relaxation rate(R2*)and renal cortical renal blood flow(RBF)were measured.One-way ANOVA was used to compare the differences in R2*and RBF among the three groups.Receiver operating characteristic curve was used to analyze relevant parameters to identify the diagnostic effectiveness of each group,and area under the curve(AUC)was compared by Z-test.ResultsThere were significant differences in renal medullary R2*and renal cortical RBF among the control group,NAU group and MAU group(F=45.83,34.15,P<0.001).There was no significant difference in renal cortical R2*(F=2.98,P=0.056).In differentiating the control group from the NAU group,the AUC of renal medullary R2*,renal cortical RBF and their combined parameters were 0.921(95%CI 0.827-0.973),0.704(95%CI 0.578-0.811),0.964(95%CI 0.885-0.994),respectively.The AUC of combined parameters was significantly different from renal cortical RBF(Z=4.07,P<0.001),but not from renal medullary R2*(Z=1.57,P=0.117).In differentiating the NAU from the MAU group,the AUC were 0.898(95%CI 0.796-0.960),0.919(95%CI 0.823-0.973),0.985(95%CI 0.881-0.994),respectively.The AUC of combined parameters was significantly different from renal medullary R2*and renal cortical RBF(Z=2.39,P=0.017;Z=2.20,P=0.028).ConclusionsThe changes of renal oxygenation level and blood flow in

关 键 词：糖尿病 2型 磁共振成像 血氧水平依赖 动脉自旋标记 肾功能 

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]