2型糖尿病肾脏病变CEUS及VTQ指标与UAER的相关性分析

发布时间：2018-02-16 03:53

  本文关键词： 糖尿病 肾脏病变 超声造影 声触诊组织定量 尿白蛋白排泄率　出处：《华北理工大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的本研究通过超声造影(contrast-enhanced ultrasound,CEUS)定量分析技术及声触诊组织定量技术(virtual touch quantification,VTQ)检查对照组及2型糖尿病患者肾脏血流灌注及肾组织弹性情况,分析相关参数,并对2型糖尿病肾脏病变患者CEUS及VTQ的相应超声指标与尿白蛋白排泄率(urinary albumin excretion rate,UAER)之间进行单因素及多因素分析,探索糖尿病肾脏病变(diabetic kidney disease,DKD)早期改变的无创超声影像学指标,以便对临床的早期诊断及治疗提供更多影像学信息。方法依据1999年WHO糖尿病诊断标准选取唐山市工人医院内分泌科2013年12月~2014年12月住院的2型糖尿病(type 2 diabetes mellitus,T2DM)患者90例(男性47例,女性43例,年龄范围28~68岁,平均年龄52.03±11.08岁)。并按性别、年龄匹配同期选择对照组30例(男15例,女15例,年龄30~68岁,平均51.37±9.59岁)。依据Mogensen分期,以UAER作为评价指标,将糖尿病患者分为3组:正常白蛋白尿组(A组)、微量白蛋白尿组(B组)及临床蛋白尿组(C组)。采用Philips i U 22及Siemens S2000彩色多普勒超声诊断仪对所有研究对象分别进行CEUS及VTQ检查,测量反映肾脏血流灌注的超声造影定量参数,包括曲线上升时间(rise time,RT)、曲线下面积(area under curve,AUC)、曲线达峰绝对值(derived peak intensity,DPI)、曲线达峰时间(time to peak,TTP)和浓度降半时间(Time from peak to one half);测量反映肾组织弹性顺应力的的横向剪切波速度(shear wave velocity,Vs)。对所有研究对象记录一般临床资料(身高、体重、血压等)及相关实验室检查,主要包括:24h尿白蛋白排泄率(UAER)、血清总胆固醇(TC)、高密度脂蛋白(HDL-C)、甘油三酯(TG)、糖化血红蛋白(Hb Alc)、低密度脂蛋白(LDL-C)及空腹血糖(FBG)。所有数据分析应用SPSS19.0统计软件包进行统计分析,计量资料的正态性检验用K-S拟合优度检验,正态分布的计量资料用均数±标准差(x±s)表示,多组数据间比较用one-way ANOVA,经Levene方差齐性检验,方差齐时组间比较采用LSD法,方差不齐时采用Dunnett’s T3法;计数资料用百分率表示,采用行×列的卡方检验进行组间率的比较。分析UAER与肾皮质血流灌注参数、肾实质及肾窦部Vs的相关性,并计算相关系数。采用多因素非条件Logistic回归分析DKD的影响因素,并采用ROC曲线图,结合灵敏度及特异度取最大切点值,估测相关指标评估早期DKD的界值。检验水准:P0.05表示差异有统计学意义。结果1 3组糖尿病患者与对照组在性别、年龄、TG、HDL-C、TC、LDL-C、SBP、DBP、BMI之间差异均无统计学意义(P0.05),有无糖尿病家族史之间差异有统计学意义(P0.01)。3组糖尿病患者间病程、FBG、Hb Alc两两比较,C组的糖尿病病程、FBG及Hb Alc均高于A组、B组,差异有统计学意义(P0.01),A组与B组之间差异无统计学意义。2 CEUS能够清晰地显示造影剂在肾脏灌注的整个过程。3组糖尿病患者及对照组各组内左、右侧肾脏CEUS相关参数之间差异均无统计学意义(P0.05)。对照组、A组、B组及C组比较,DPI依次减小,组间差异具有统计学意义(P0.01);与对照组比较,A组、B组患者AUC明显增高,C组患者AUC明显降低,差异均具有显著统计学意义(P0.01);B组、C组患者TTP、RT较对照组明显延长(P0.05),A组患者与对照组差异无统计学意义(P0.05);A组、B组、对照组间两两比较浓度降半时间差异无统计学意义,C组与对照组比较浓度降半时间明显延长,组间差异具有统计学意义(P0.05)。3 3组糖尿病患者及对照组各组内左、右侧肾脏的肾实质Vs之间;左、右侧肾脏的肾窦部Vs之间分别比较,差异均无统计学意义(P0.05)。所有研究对象肾脏肾实质Vs肾窦部Vs,差异有统计学意义(P0.01)。与对照组比,C组患者肾实质Vs低于对照组,差异具有统计学意义(P=0.020.05),C组肾窦部Vs与对照组比较差异无统计学意义(P0.05)。A组、B组的肾实质、肾窦部Vs分别与对照组比较,差异无统计学意义(P0.05)。3组糖尿病患者之间两两比较,A组、B组患者肾实质Vs高于C组患者肾实质Vs,差异具有统计学意义(P0.05);A组、B组患者肾实质Vs之间差异无统计学意义(P0.05)。A组、B组、C组3组之间肾窦部Vs差异均无统计学意义(P0.05)。4经Spearman相关性分析,UAER与RT、TTP及浓度降半时间呈明显正相关(P0.01),与DPI及肾实质Vs呈明显负相关(P0.01),与肾窦部Vs无明显相关性(P0.05)。5以UAER是否异常为因变量,对观察指标进行多因素非条件Logistic回归分析结果显示:空腹血糖、糖尿病病程、Hb A1C、家族糖尿病、喜荤食及RT、DPI是UAER出现异常的危险因素,即出现早期DKD的危险性增加;根据ROC曲线,选取RT、DPI界值分别在15.94s、13.53d B时,其在评估早期DN的灵敏度分别为81.8%、68.2%,特异度分别为80.4%、87.0%,而且RT与DPI之间具有较好的一致性,当RT与DPI并联组合时,其灵敏度和特异度分别为88.6%、78.3%。结论1 CEUS技术能够分析DKD患者血流灌注参数的改变,DKD早期RT、AUC、DPI及TTP已出现异常,可以作为评估DKD患者早期肾功能异常的重要指标。2UAER与肾皮质血流灌注参数RT、TTP、浓度降半时间呈明显正相关,与DPI呈明显负相关,随着病情加重,RT、TTP及浓度降半时间越来越长,DPI降低。3 RT、DPI值在一定程度上能够较准确地判断早期DKD肾脏损害程度,为DKD早期诊断提供新的参考依据。4 VTQ技术测量Vs值可以量化评估DKD患者肾脏弹性,肾实质区肾窦区,且肾实质区的Vs值与患者肾损害程度呈明显负相关,随着肾损害的加重,Vs值越低,为DKD患者的诊断提供一种新的无创的定量评估指标。
[Abstract]:The purpose of this study by contrast enhanced ultrasound (contrast-enhanced ultrasound, CEUS) quantitative analysis technology and virtual touch tissue quantification (virtual touch, quantification, VTQ) to check the control group and patients with type 2 diabetes mellitus renal blood perfusion and renal tissue elasticity, analysis of related parameters, the corresponding ultrasonic index and urinary albumin excretion in type 2 diabetes and kidney disease patients with CEUS and VTQ (urinary albumin excretion rate rate, UAER) between single factor and multiple factor analysis, to explore the diabetic nephropathy (diabetic kidney, disease, DKD) noninvasive ultrasound imaging index in the early period of change, so that the clinical early diagnosis and treatment to provide more imaging information. According to the 1999 WHO diabetes diagnostic criteria for selection of Tangshan City workers' Hospital Department of endocrinology in December 2013 December ~2014 diagnosed type 2 diabetes (type diabetes 2 mellitus, T2DM) patients In 90 cases (male 47 cases, female 43 cases, age range 28~68 years, mean age 52.03 + 11.08 years). According to gender, age, and selected 30 cases of the control group (male 15 cases, female 15 cases, age 30~68 years old, average 51.37 + 9.59 years). According to Mogensen staging, UAER as the evaluation index, the diabetic patients were divided into 3 groups: normal albuminuria group (group A), microalbuminuria group (group B) and clinical albuminuria group (group C). Using Philips I U 22 and Siemens S2000 color Doppler ultrasonic diagnostic apparatus for all subjects were performed CEUS and VTQ examination, measurement of reflection quantitative parameters of contrast-enhanced ultrasound of renal blood perfusion, including the curve rise time (rise time, RT), the area under the curve (area under, curve, AUC), the curve of peak absolute value (derived peak intensity, DPI), curve peak time (time to, peak, TTP) and the concentration of half time (Time from peak to one half); measuring reflection The transverse shear wave velocity of renal tissue elastic compliance of the (shear wave velocity, Vs). The clinical data records for all subjects (height, weight, blood pressure, etc.) and related laboratory tests, including: 24h urinary albumin excretion rate (UAER), serum total cholesterol (TC), high density lipoprotein protein (HDL-C), triglyceride (TG), glycosylated hemoglobin (Hb Alc), low density lipoprotein (LDL-C) and fasting blood glucose (FBG). All data were analyzed using the SPSS19.0 statistical software package for statistical analysis, using K-S goodness-of-fit test measurement data normality test, standard deviation measurement the data of normal distribution (x + s) said that many sets of data were compared with one-way ANOVA, the Levene homogeneity of variance test, variance between groups when compared with LSD method, the variance not neat using Dunnett s T3 method; count data expressed as a percentage, chi square test for X column between groups The rate of UAER. The comparison with the renal cortex blood perfusion parameters, correlation between renal parenchyma and renal sinus Vs, the correlation coefficient is calculated. By multi factor non conditional Logistic regression analysis the influencing factors of DKD, and the ROC curve, combined with the sensitivity and specificity of the maximum cut-off value, estimate the evaluation of early DKD boundary value. Inspection level: P0.05 said the difference was statistically significant. The results of 13 groups of diabetic patients and control groups in gender, age, TG, HDL-C, TC, LDL-C, SBP, DBP, BMI were no significant differences between (P0.05), the difference between no family history of diabetes was statistically significant (P0.01.3) group of patients between the course of disease, FBG, Hb 22 Alc, duration of diabetes group C, FBG and Hb Alc were higher than A group, B group, the difference was statistically significant (P0.01), A group and B group had no significant difference.2 CEUS can clearly display the contrast agent in the kidney The whole process of.3 perfusion in patients with diabetes mellitus group and control group in each group left, the difference between the right kidney CEUS related parameters were not statistically significant (P0.05). The control group, A group, B group and C group, DPI decreased, the difference was statistically significant (P0.01); compared with the control group, A group B, AUC groups were significantly higher in C group, AUC decreased significantly, the difference was statistically significant (P0.01); B group, C group TTP, RT was significantly longer than that of the control group (P0.05), the A group and the control group had no significant difference (P0.05); A group, B group, control comparison between the 22 groups was half time was no significant difference between C group and control group the concentration of half time was prolonged, the differences between groups was statistically significant (P0.05.3) 3 groups of diabetic patients and control groups in the left and right renal parenchyma between Vs; left between kidney antrum the right of Vs respectively. 杈，

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