血氧水平依赖磁共振成像评价糖尿病肾病的初步研究

发布时间：2018-03-09 00:22

本文选题：肾皮质　切入点：肾髓质　出处：《苏州大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨血氧水平依赖磁共振成像评价糖尿病肾病(diabetic nephropathy, DN)的临床应用价值。材料与方法：研究11例健康志愿者,19例早期糖尿病肾病患者(eGFR60ml/min/1.73m2,伴微量或大量蛋白尿),15例中晚期糖尿病肾病患者(eGFR≤60ml/min/1.73m2,伴大量蛋白尿)。采用Siemens Magnetom Verio3.0T磁共振进行BOLD序列扫描,分别测量、计算三组患者双肾的皮、髓质R2*值及髓质/皮质R2*比值。采用单因素方差分析(ANOVA)进行组间两两比较。用ROC曲线分析诊断效能。采用Peason法分别将皮、髓质的R2*值及髓质/皮质R2*比值与临床指标(估算肾小球滤过率eGFR、糖化血红蛋白HbA1c)进行相关性分析。结果： 1)T2*伪彩图上,正常对照组皮质呈条片状蓝色,而糖尿病肾病皮质呈弥漫蓝点状改变,早期DN组占63.2%(12/19),中晚期DN组占66.7%(10/15)。 2)正常对照组与早期DN组之间髓质R2*具有显著统计学差异(P0.01),具有诊断效能(P0.01),阈值为33.88s-1,敏感度及特异度分别为94.74%和90.91%。 3)早期DN组与中晚期DN组之间皮质R2*及髓质/皮质R2*比值具有显著统计学差异(P0.01),其中皮质R2*值具有更高的诊断效能(P0.01),阈值为17.63S-1,敏感度与特异度分别为80%和84.21%。 4)正常对照组与中晚期DN组之间皮质R2*及髓质/皮质R2*比值具有统计学差异(P0.05),其中皮质具有诊断效能(P0.01),阈值为16.86s-1,敏感度和特异度分别在93.33%和100%。髓质/皮质R2*比值没有诊断效能(P0.05)。 5)皮质R2*值与eGFR呈负相关(r=-0.492,P0.01),髓质/皮质R2*比值与eGFR呈正相关(r=0.423,P0.05)。皮质R2*值、髓质R2*值及髓质/皮质R2*比值均与HbA1c无相关性。结论： 1)糖尿病肾病T2*伪彩图皮质弥漫蓝点状改变具有一定的特征性。 2) BOLD-MRI可用于糖尿病肾病的诊断与分期。本研究中髓质R2*值可用于鉴别正常组及早期DN组,皮质R2*值可用于鉴别早期DN组与中晚期DN组以及正常组与中晚期DN组。 3)皮质R2*值与eGFR呈负相关,髓质/皮质R2*比值与eGFR呈正相关,可用于检测糖尿病肾病进展情况。
[Abstract]:Objective:. To evaluate the clinical value of blood oxygen level dependent magnetic resonance imaging (MRI) in the evaluation of diabetic nephropathy (DNs). Materials and methods:. Eleven healthy volunteers were studied in 19 patients with early diabetic nephropathy, 19 patients with early diabetic nephropathy, 19 patients with early diabetic nephropathy, 15 patients with moderate or advanced diabetic nephropathy with microalbuminuria, 15 patients with middle and late stage diabetic nephropathy, and 15 patients with advanced diabetic nephropathy, with large proteinuria. Siemens Magnetom Verio3.0T magnetic resonance imaging (Siemens Magnetom Verio3.0T) was used to perform BOLD sequence scanning, respectively. The skin and medullary R2 * values and medullary / cortical R2 * ratio of the three groups were calculated. The results were compared by single factor variance analysis (ANOVA). The diagnostic efficacy was analyzed by ROC curve. The skin was divided into two groups by Peason method. The R2 * value of medulla and the ratio of medullary / cortical R2 * were correlated with clinical indexes (estimated glomerular filtration rate (GFR) HbA1c). Results:. On the pseudochromatic images of T2 *, the cortex of normal control group was striped blue, while the cortex of diabetic nephropathy showed diffuse blue dot changes. The early DN group accounted for 63.2% and the middle and late DN group accounted for 66.7% of 15%. 2) there was significant difference in medullary R2 * between the normal control group and the early DN group (P 0.01), the diagnostic efficacy was P 0.01, the threshold value was 33.88 s-1.The sensitivity and specificity were 94.74% and 90.91 respectively. 3) the cortical R2 * and the ratio of medullary / cortical R2 * were significantly different between the early DN group and the middle and late DN group. The cortical R2 * value had higher diagnostic efficacy (P 0.01), the threshold value was 17.63 S-1, the sensitivity and specificity were 80% and 84.21, respectively. 4) the cortical R2 * and the ratio of medullary / cortical R2 * were significantly different between the normal control group and the advanced DN group (P 0.05), in which the cortex had diagnostic efficacy (P 0.01), the threshold value was 16.86s-1, the sensitivity and specificity were 93.33% and 100g, respectively. The medullary / cortical R2 * ratio had no diagnostic efficacy (P0.05). 5) the cortical R2 * value was negatively correlated with eGFR and the ratio of medullary / cortical R2 * was positively correlated with eGFR. The cortical R2 * value, medullary R2 * value and medullary / cortical R2 * ratio were not correlated with HbA1c. Conclusion:. 1) the diffuse blue dot change of T 2 * pseudochromogram in diabetic nephropathy is characteristic. 2) BOLD-MRI can be used in the diagnosis and staging of diabetic nephropathy. In this study, the medullary R2 * value can be used to differentiate normal group from early DN group, and cortical R2 * value to differentiate early DN group from middle and late DN group and normal group from late DN group. 3) the cortical R2 * value was negatively correlated with eGFR, and the medullary / cortical R2 * ratio was positively correlated with eGFR, which could be used to detect the progression of diabetic nephropathy.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R587.2;R445.2

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