肾脏血氧水平依赖磁共振成像在糖尿病肾病的初步应用研究

发布时间：2018-03-07 17:36

本文选题：肾脏　切入点：磁共振成像　出处：《天津医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：本研究运用血氧水平依赖磁共振成像(BOLD MRI)探讨2型糖尿病及其肾病患者肾脏的BOLD成像特点,评估其肾脏皮髓质的氧合状态,并分析肾脏皮髓质R2*值与血清胱抑素C (Cys C)、肾小球滤过率估算值(eGFR)之间的相关性,以期探寻一种无创、敏感的评价肾功能的方法。方法：选取天津市第四中心医院2014年3月至2015年3月于内分泌科住院部收治的2型糖尿病(T2DM)患者共21例,均符合1999年美国糖尿病协会(ADA)提出的2型糖尿病诊断标准,其中糖尿病肾病(DKD)患者8例,单纯2型糖尿病患者13例。纳入的单纯2型糖尿病患者均无糖尿病各种急慢性并发症和各种原因所致的急、慢性肾病。所有患者需测量血清Cys C、血清肌酐(Scr),并根据简化肾脏病膳食改良试验方程(MDRD)估算肾小球滤过率(GFR)。另外选取与受试患者年龄、性别相匹配的健康志愿者20例。经医院伦理委员会批准,所有受试者均签署了知情同意书。采用3.0T磁共振扫描仪(Achieva TX, Philips Healthcare)对所有受试者进行肾脏常规MRI及冠状位BOLD扫描。分别测量各组肾皮质、髓质的R2*值,采用配对样本t检验比较各组肾脏皮质与髓质之间R2*值的差异,采用单因素方差分析比较各组之间肾脏皮质间、髓质间R2*值的差异。2型糖尿病及其肾病组肾脏皮、髓质R2*值与血清Cys C、eGFR之间的相关性采用Pearson相关性分析方法。结果：所有受试者全部纳入图像分析。健康对照组、单纯T2DM组与DKD组肾脏髓质R2*值均显著高于皮质(P0.001)。经单因素方差分析显示,健康对照组、单纯T2DM组与DKD组之间肾脏皮质、髓质R2*值均存在统计学差异(P0.05)。Tukey检验进行两两比较显示,DKD组较单纯T2DM组及正常对照组皮质R2*值均明显增加(P0.05),而单纯T2DM组与健康对照组皮质R2*值之间无统计学差异(P0.05)；单纯T2DM组与DKD组髓质R2*值较健康对照组均明显增加,而DKD组髓质R2*值低于单纯T2DM组,差异具有统计学意义(P0.05)。Pearson相关性分析显示,单纯T2DM组髓质R2*值与血清Cys C、eGFR均呈正相关(P0.05)；单纯T2DM组皮质R2*值与eGFR、血清Cys C均无明显相关性(P0.05)；DKD组皮、髓质R2*值均与血清Cys C呈正相关(P0.05),与eGFR呈负相关(P0.05),其中以皮质R2*值与血清Cys C之间的相关强度最高。结论：BOLD MRI能够无创、敏感、可靠地评估正常人与2型糖尿病及其肾病患者肾脏皮髓质氧合水平。正常人肾脏髓质处于生理性缺氧状态,2型糖尿病患者肾髓质显著缺氧,而糖尿病肾病患者皮髓质均显著缺氧,皮髓质R2*值的改变可以反映肾功能的变化。
[Abstract]:Objective: to investigate the characteristics of renal BOLD imaging in patients with type 2 diabetes mellitus and its nephropathy by using blood oxygen level dependent magnetic resonance imaging (bod MRI), and to evaluate the oxygenation status of renal medulla. The correlation between R2 * value of renal skin medulla and serum cystatin C cystein-Cys Con, glomerular filtration rate (GFR) was analyzed in order to explore a non-invasive method. Methods: a total of 21 patients with type 2 diabetes mellitus (T2DM) admitted from March 2014 to March 2015 in Department of Endocrinology in Tianjin 4th Central Hospital were selected. All of them were in accordance with the diagnostic criteria for type 2 diabetes proposed by the American Diabetes Association (ADA) in 1999, including 8 patients with diabetic nephropathy (DKD). There were 13 patients with type 2 diabetes mellitus. All the patients with type 2 diabetes did not have all kinds of acute and chronic complications of diabetes and the urgency caused by various causes. Chronic nephropathy. All patients should measure serum Cys C, serum creatinine creatinine, and estimate glomerular filtration rate (GFR) according to simplified dietary improvement test equation. 20 sex-matched healthy volunteers, approved by the Hospital Ethics Committee, All the subjects signed the informed consent form. All subjects were examined with conventional MRI and coronal BOLD scanning using 3.0T MRI scanner Achieva TX, Philips Healthcare. The R2 * values of renal cortex and medulla were measured in each group. The difference of R2 * value between renal cortex and medulla in each group was compared by paired sample t test, and the difference of R2 * value between renal cortex and medulla between each group was compared by univariate analysis of variance (ANOVA). 2 the renal skin of type 2 diabetes mellitus and its nephropathy group were compared by single factor analysis of variance (ANOVA). The correlation between medullary R2 * value and serum Cys CfGFR was analyzed by Pearson method. Results: all subjects were included in the image analysis. The R2 * value of renal medulla in simple T2DM group and DKD group was significantly higher than that in cortical cortex P0.001.The univariate analysis of variance showed that the renal cortex of healthy control group, simple T2DM group and DKD group was significantly higher than that of DKD group. There was significant difference in R2 * value of medulla between two groups (P0.05U. Tukey test). The results showed that the R2 * value of cortex in DKD group was significantly higher than that in T2DM group and normal control group, but there was no significant difference in R2 * value between T2DM group and healthy control group (P0.05). The medullary R2 * value in T2DM group and DKD group was significantly higher than that in healthy control group. The medullary R2 * value in DKD group was significantly lower than that in T2DM group. Pearson correlation analysis showed that the medullary R2 * value in T2DM group was positively correlated with serum Cys Cngfr value (P0.05), the cortical R2 * value in T2DM group had no significant correlation with eGFRand the serum Cys C level had no significant correlation with the skin of T2DM group, and there was no significant correlation between R2 * value and EGF R2 * value in T2DM group, and there was no significant correlation between R2 * value and serum Cys C in T2DM group. The medullary R2 * values were positively correlated with serum Cys C and negatively correlated with eGFR. The cortical R2 * value and serum Cys C had the highest correlation intensity. The renal medullary oxygenation levels in normal subjects and patients with type 2 diabetes mellitus and their nephropathy were evaluated reliably. The renal medulla in normal subjects was in a physiologic anoxic state and the renal medulla was significantly hypoxic in patients with type 2 diabetes mellitus. The medulla of diabetic nephropathy patients were significantly hypoxic, and the change of R2 * value of skin medulla could reflect the change of renal function.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.2;R445.2

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