彩色多普勒超声检查肾动脉血流对诊断糖尿病肾病的价值

发布时间：2018-03-09 01:11

本文选题：肾内动脉血流阻力指数（RI）　切入点：糖尿病肾病　出处：《大连医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：糖尿病（diatebes，DM）作为一种常见疾病，多发病，其得病率正跟着人们生活水平的升高、人口老龄化、生活方式的转变而迅速增加，糖尿病已成为世界第一大慢性疾病。各种急慢性并发症是糖尿病造成危害的主要原因。糖尿病肾病（diabetic nephropathy，DN）是糖尿病微血管病变在肾脏的体现，是DM最常见的并发症，是造成终末期肾功能衰竭的主要原因。糖尿病肾病的医治当前尚缺乏有效措施，是以糖尿病患者一旦产生肾脏损害，病情逐渐呈进行性发展趋势，直到导致尿毒症。因此，糖尿病肾病的及早发现和预防即尤为重要。本文对正常人群、糖尿病患者及非糖尿病病人肾内动脉阻力指数（RI）进行了比较分析，以期为DN的早期诊断提供有价值的检查方法。研究方法：选用GE Logiq7和阿洛卡α10彩色多普勒超声诊断仪，探头频率为2.5~3.5MHz行彩色频谱多普勒测定。当肾动脉彩色血流信号显示清晰时，嘱患者屏住呼吸，测定患者肾门处主肾动脉、肾内段间动脉及叶间动脉血流参数，并计算肾动脉血流阻力指数（RI）。研究对象：正常对照组为健康体检人群，，无既往病史，16例；非糖尿病组：有既往病史（包括高血压、脂肪肝、冠状动脉粥样硬化性心脏病等），但非糖尿病患者，21例；糖尿病组：根据世界卫生组织（WHO）用于糖尿病的暂行标准诊断为糖尿病患者的诊断，均为2型DM，23例；其中病程1-5年12例，6-20年11例，对糖尿病患者分别于治疗前及治疗后进行检测。结果： 1.糖尿病患者RI与健康人群及非糖尿病患者RI的比较分析显示，糖尿病组治疗前RI与同组健康人群对照组RI比较有显著差异（p0.05），而与非糖尿病（包括高血压、脂肪肝、冠状动脉粥样硬化性心脏病等）比较没有表现出明显差异。糖尿病组经临床降糖治疗后RI值有所下降，但未见显著差异。 2.糖尿病肾病患者RI与糖尿病病程相关性分析结果可见，糖尿病DM患病6年以上患者治疗前RI和治疗后RI均明显高于患病5年以下患者治疗前及治疗后RI，统计学分析均有显著差异。 3.糖尿病患者肾内动脉阻力指数RI与年龄的相关性分析结果显示，治疗前新发现糖尿病患者RI高年龄组高于低年龄组，二者有显著差异；降糖治疗后糖尿病患者RI高年龄组与低年龄组呈平行下降趋势，二者仍有显著差异。结论： 1.糖尿病患者RI明显高于健康人群对照组RI，可作为糖尿病肾病诊断指标之一，降糖治疗可部分改善肾动脉高阻状态。 2.肾动脉阻力指数（RI）血流动力学的变化可以反映糖尿病肾病和糖尿病肾病的不同阶段，血管，和疾病的进展呈正相关。 3.糖尿病患者肾内动脉阻力指数RI与患病年龄呈正相关。
[Abstract]:Objective: as a common disease, the incidence of diabetes mellitus (DM) is increasing rapidly with the increase of people's living standard, the aging population and the change of life style. Diabetes has become the largest chronic disease in the world. All kinds of acute and chronic complications are the main causes of the damage caused by diabetes. Diabetic nephropathy is the manifestation of diabetic microangiopathy in the kidney, and it is the most common complication of DM. Is the main cause of end-stage renal failure. The treatment of diabetic nephropathy is still lack of effective measures, is that once diabetic patients have kidney damage, the disease gradually shows a progressive development trend, until lead to uremia. Therefore, Early detection and prevention of diabetic nephropathy is particularly important. This paper makes a comparative analysis of the resistance index (RI) of the renal artery in normal, diabetic and non-diabetic patients in order to provide a valuable method for the early diagnosis of DN. Methods: GE Logiq7 and Aloka 伪 10 color Doppler ultrasound diagnostic instrument were used, and the probe frequency was 2.5 ~ 3.5MHz. When the color blood flow signal of renal artery was clear, the patient was told to hold his breath. The blood flow parameters of main renal artery, intersegmental intersegmental artery and interlobar artery were measured, and the resistance index of renal artery was calculated. In the non-diabetic group, there were 21 cases of non-diabetic patients with previous history (including hypertension, fatty liver, coronary atherosclerotic heart disease, etc.). Diabetes group: according to the World Health Organization (WHO) temporary criteria for the diagnosis of diabetes, 23 cases of type 2 DMN were diagnosed, of which 12 cases were from 1 to 5 years and 11 cases were from 6 to 20 years. The diabetes patients were detected before and after treatment. Results:. 1. The RI of diabetic patients was significantly higher than that of the control group (P < 0.05), but it was significantly different from that of non-diabetic patients (including hypertension, fatty liver), the RI of diabetic patients was significantly higher than that of control group (P < 0.05), and that of non-diabetic patients (including hypertension, fatty liver) was higher than that of control group (P < 0.05). There was no significant difference in coronary atherosclerotic heart disease, but no significant difference was found in the RI value of diabetic group after clinical hypoglycemic therapy. 2. The results of the correlation analysis between RI and the course of diabetes in patients with diabetic nephropathy can be seen. The RI before and after treatment were significantly higher in DM patients than in patients with DM less than 5 years before and after treatment, and there were significant differences between the two groups. 3. The correlation analysis of RI and age in diabetic patients showed that the RI of high age group was higher than that of low age group before treatment, and there was a significant difference between them. After hypoglycemic therapy, RI of diabetes mellitus patients showed a parallel downward trend between the high age group and the low age group, and there was still significant difference between the two groups. Conclusion:. 1. RI of diabetic patients was significantly higher than that of healthy controls, and could be used as one of the diagnostic indexes of diabetic nephropathy. Hypoglycemic therapy could partly improve the high resistance of renal artery. 2. The changes of renal artery resistance index (RI) hemodynamics can reflect the different stages of diabetic nephropathy and diabetic nephropathy, and the blood vessels are positively correlated with the progression of the disease. 3. There was a positive correlation between RI and age in diabetic patients.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R587.2;R445.1

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