利用SPECT影像技术评估糖尿病视网膜病变与糖尿病肾病的相关性  

Correlation Between Diabetic Retinopathy and Diabetic Nephropathy by SPECT Imaging Technique

作　　者：李盈 李涛 王潇 唐娟 王大庆[1,2] LI Ying;LI Tao;WANG Xiao;TANG Juan;WANG Da-qing(Department of Ophthalmology,the Affiliated Hospital of North Sichuan Medical University,Nanchong 637000,Sichuan,China;Department of Ophthalmology,Ziyang Central Hospital,Ziyang 641300,Sichuan,China;Key Laboratory of Ophthalmology,Ziyang Central Hospital,Ziyang 641300,Sichuan,China;Department of Otolaryngology-Head and Neck Surgery,Ziyang Central Hospital,Ziyang 641300,Sichuan,China;Department of Endocrinology,Ziyang Central Hospital,Ziyang 641300,Sichuan China)

机构地区：[1]川北医学院附属医院眼科,四川南充637000 [2]资阳市中心医院眼科,四川资阳641300 [3]资阳市中心医院眼科重点实验室,四川资阳641300 [4]资阳市中心医院耳鼻咽喉头颈外科,四川资阳641300 [5]资阳市中心医院内分泌科,四川资阳641300

出　　处：《医学信息》2024年第5期108-112,共5页Journal of Medical Information

基　　金：四川省资阳市科学技术局2023年度第二批市级科研计划项目(编号:zykjjsc20-yyjc-2023-04)。

摘　　要：目的 采用SPECT影像技术探索糖尿病视网膜病变(DR)与糖尿病肾病(DKD)的相关性。方法 回顾性分析2022年3月-2023年4月就诊于资阳市中心医院明确诊断为2型糖尿病(T2DM)视网膜病变患者250例,按照世界卫生组织制定的DR分期标准进行分组,分为无明显DR(Non-DR)组、轻度NPDR组、中度NPDR组、重度NPDR组和PDR组,共5组,每组50例。其中男115例(230眼),女135例(270眼),均采用99m Tc-DTPA核素肾动态显像技术测定肾小球滤过率(GFR)。比较不同DR分组中TG、TC、HDL-C、LDL-C、HbA1c、Scr、BUN、UAlb、ACR、m ALb、GFR水平,以及无明显DR、轻度NPDR、中度NPDR、重度NPDR和PDR组中DKD发病率。结果 与无明显DR组比较,轻、中、重度NPDR和PDR组HbA1c、TG、TC、LDL-C、Scr、BUN、UAlb和ACR水平逐渐升高,HDL-C、GFR逐渐降低(P<0.05)。Logistic回归分析显示,DR与Scr、BUN、UAlb、ACR和GFR显著相关(P<0.05);DR患者中,DKD的总体发病率为43.24%,与无明显DR比较,轻、中、重度NPDR和PDR组的DKD发病率逐渐增加(P<0.05)。肾动态SPECT成像技术分析显示,与无明显DR比较,轻、中、重度NPDR和PDR组的肾区面积、肾脏深度逐渐增大,血液灌注率、吸收率及GFR逐渐降低(P<0.05),各组峰值时间比较,差异无统计学意义(P>0.05)。结论 在DR患者中早期采用SPECT成像技术进行肾病筛查,可早期、无创筛查出DKD,及时采取干预措施,将有效延缓DKD的发展,提高糖尿病患者的生存质量。Objective To explore the correlation between diabetic retinopathy(DR)and diabetic kidney disease(DKD)by SPECT imaging.Methods A retrospective analysis of 250 patients with type 2 diabetic(T2DM)retinopathydiagnosed in Ziyang Central Hospital from March 2022 to April 2023 was performed.According to the DR staging criteria established by the World Health Organization,the patients were divided into five groups:non-DR(Non-DR)group,mild NPDR group,moderate NPDR group,severe NPDR group and PDR group,with 50 patients in each group.Glomerular filtration rate(GFR)was measured by 99m Tc-DTPA renal dynamic imaging in 115 males(230 eyes)and 135 females(270 eyes).The levels of TG,TC,HDL-C,LDL-C,HbA1c,Scr,BUN,UAlb,ACR,mALb and GFR in different DR groups were compared,as well as the incidence of DKD in non-DR,mild NPDR,moderate NPDR,severe NPDR and PDR groups.Results Compared with non-DR group,the levels of HbA1c,TG,TC,LDL-C,Scr,BUN,UAlb and ACR in mild,moderate and severe NPDR and PDR groups increased gradually,while HDL-C and GFR decreased gradually(P<0.05).Logistic regression analysis showed that DR was significantly correlated with Scr,BUN,UAlb,ACR and GFR(P<0.05).In DR patients,the overall incidence of DKD was 43.24%.Compared with non-DR,the incidence of DKD in mild,moderate,severe NPDR and PDR groups increased gradually(P<0.05).The analysis of renal dynamic SPECT imaging technology showed that compared with no obvious DR,the renal area and renal depth of mild,moderate,severe NPDR and PDR groups gradually increased,and the blood perfusion rate,absorption rate and GFR gradually decreased(P<0.05).There was no significant difference in peak time among the groups(P>0.05).Conclusion In DR patients,early use of SPECT imaging technology for kidney disease screening can early and non-invasively screen out DKD.Timely intervention measures will effectively delay the development of DKD and improve the quality of life of diabetic patients.

关 键 词：SPECT 2型糖尿病 糖尿病性视网膜病变 糖尿病肾病 

分 类 号：R587.2[医药卫生—内分泌] R774.1[医药卫生—内科学] R445.3[医药卫生—临床医学]