超声微血流成像联合血清炎症因子对糖尿病肾病的诊断价值  

Value of ultrasound micro-flow imaging combined with serum inflammatory factors in the diagnosis of diabetic kidney disease

作　　者：张栋杰 郑曙光[2] 张行健 刘丛聪 汤贞林 马瑞霞[1] ZHANG Dongjie;ZHENG Shuguang;ZHANG Xingjian;LIU Congcong;TANG Zhenlin;MA Ruixia(Department of Nephrology,The Affiliated Hospital of Qingdao Univesity,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院肾病科,山东青岛266003 [2]青岛大学附属医院超声科,山东青岛266003

出　　处：《精准医学杂志》2024年第4期356-360,共5页Journal of Precision Medicine

基　　金：山东省自然科学基金项目(ZR2022MH161);泰山学者工程专项项目(tstp20230665);青岛市医药卫生科研计划项目(2021-WJZD189)。

摘　　要：目的探究超声微血流成像(MFI)联合血清炎症因子对糖尿病肾病(diabetic kidney disease,DKD)早期诊断的价值。方法选取2022年6月1日—2023年6月30日青岛大学附属医院收治的92例DKD患者为DKD组,另选取同期本院收治的64例2型糖尿病(T2DM)患者为T2DM组,收集两组患者的临床相关指标、超声血流参数以及血清炎症因子水平。超声血流参数包括MFI值、左肾叶间动脉阻力指数(RI_(1))、右肾叶间动脉阻力指数(RI_(2))、左肾叶间动脉峰值流速(PSV_(1))、右肾叶间动脉峰值流速(PSV_(2))。采用Spearman方法分析MFI值与临床指标、血清炎症因子的相关性,二元logistic回归中向前有条件的方法分析DKD的影响因素,以受试者工作特征(ROC)曲线分析MFI值和血清炎症因子对DKD的预测价值。结果T2DM组RI_(1)及血液中C-反应蛋白(CRP)、IL-6、IL-18水平低于DKD组(Z=-6.73~-3.20,P<0.05),而MFI值、PSV_(2)水平高于DKD组(Z=-9.53、-2.67,P<0.05)。MFI值与血红蛋白(HB)水平、估算肾小球滤过率(eGFR)呈正相关,与血肌酐(Scr)、尿微量白蛋白肌酐比值(UACR)呈负相关;血清IL-6与Scr、UACR呈正相关,与HB、eGFR呈负相关。二元logistic回归分析显示,MFI值(OR=0.596,95%CI=0.473~0.751)、血清IL-6(OR=2.184,95%CI=1.243~3.839)均对DKD的诊断具有提示作用(P<0.05)。MFI值、血清IL-6单独诊断T2DM患者发生DKD的曲线下面积(AUC)分别为0.949(95%CI=0.909~0.989)、0.830(95%CI=0.767~0.892),两者联合诊断的AUC为0.970(95%CI=0.942~0.999)。结论MFI值联合血清IL-6水平检测可提升DKD早期临床诊断率,可为DKD的监测和预防提供借鉴。Objective To investigate the value of ultrasound micro-flow imaging(MFI)combined with serum inflammatory factors in the early diagnosis of diabetic kidney disease(DKD).Methods A total of 92 patients with DKD who were admitted to The Affiliated Hospital of Qingdao University from June 1,2022 to June 30,2023 were enrolled as DKD group,and 64 patients with type 2 diabetes mellitus(T2DM)who were admitted to our hospital during the same period of time were enrolled as T2DM group.Related data were collected for the two groups,including clinical indicators,ultrasound blood flow parameters,and serum inflammatory factors.Ultrasound blood flow parameters included MFI-value,left renal interlobar artery resistance index(RI_(1)),right renal interlobar artery resistance index(RI_(2)),left renal interlobar arterial peak velocity(PSV_(1)),and right renal interlobar arterial peak velocity(PSV_(2)).The Spearman method was used to investigate the correlation of MFI-value with clinical indicators and serum inflammatory factors;the forward conditional approach in binary logistic regression was used to analyze the impact of DKD;the receiver operating characteristic(ROC)curve was used to analyze the value of MFI-value and serum inflammatory factors in predicting DKD.Results Compared with the DKD group,the T2DM group had significantly lower RI_(1) and serum levels of C-reactive protein,interleukin-6(IL-6),and interleukin-18(Z=-6.73--3.20,P<0.05)and significantly higher levels of MFI-value and PSV 2(Z=-9.53,-2.67,P<0.05).MFI-value was positively correlated with hemoglobin(HB)and estimated glomerular filtration rate(eGFR)and was negatively correlated with serum creatinine(Scr)and urinary albumin-to-creatinine ratio(UACR);serum IL-6 was positively correlated with Scr and UACR and was negatively correlated with HB and eGFR.The binary logistic regression analysis showed that MFI-value(OR=0.596,95%CI=0.473-0.751,P<0.05)and serum IL-6(OR=2.184,95%CI=1.243-3.839,P<0.05)showed a certain effect in the diagnosis of DKD.MFI-value and serum IL-6 alo

关 键 词：糖尿病肾病 超声检查 血流动力学 白细胞介素6 白细胞介素18 早期诊断 

分 类 号：R587.24[医药卫生—内分泌]