超声评价早期糖尿病胰腺脂肪沉积及肾组织血流灌注的临床研究
发布时间：2018-08-16 18:03
【摘要】：背景DM是慢性流行代谢障碍性疾病,表现为患病率逐年增长趋势,已经成为危害人类健康的主要疾病。胰腺脂肪沉积会大大增加T2DM的患病风险。近年来胰腺脂肪沉积和糖代谢异常的相关性研究日趋重视。超声作为一种便利,经济,快捷,可重复的检查方式用于估测糖代谢异常人群的胰腺脂肪沉积情况,分析胰腺脂肪沉积与糖尿病多种高危因素的相关性,针对各种危险因素早日采取防治措施,进一步降低胰腺脂肪沉积率可有效降低DM的患病率、延缓糖尿病病程进展。目的1.探讨超声估测胰腺脂肪沉积的可行性。2.分析胰腺脂肪沉积与多种糖尿病高危因素的相关性。方法选取年龄45~65岁(58±2)的糖尿病高发人群于2015年10月至2016年1月在上海市第六人民医院东院行DM筛查,共计294人,除外严重心脏和脑血管疾病、肝脏和肾脏功能异常、各种感染、其他胰腺急慢性疾病或肿瘤、脾脏疾病、手术或其他应激情况。采集人口学资料、现病史、既往史、人体学参数,进行生化指标和胰腺普通超声检测,以腹直肌为参照物估测胰腺脂肪沉积,依据回声分为1、2、3级。其111例DM患者定为DM组,54例糖代谢障碍者定为IGR组,糖代谢无异常129人定为健康对照组。应用社会科学统计软件包(SPSS)16.0版本对数据统计分析。各组间观察指标差异的比较采用ANOVA方法;DM多个危险因素与胰腺脂肪沉积的相关性分析采用Logistic回归分析法。P0.05为差异有统计学意义。结果1.健康组检出胰腺脂肪沉积23例(17.8%),其中2级16,3级7;IGR组检出16例(29.6%),其中2、3级分别为11、5例;DM组检出34例(30.6%),其中2、3级分别为22、12例。3组间胰腺脂肪沉积患病率有统计学意义(P0.01)。胰腺脂肪沉积检出率随糖尿病病程的进展逐渐增加(c2=19.14,P0.01)。2.TC(P=0.01)、TG(P=0.01)、LDL-C(P=0.00)、FPG(P=0.00)、HOMA2-IR(P=0.03)、HOMA-IS(P=0.00)在IGR组、DN组显著高于对照组。3.BMI、HOMA2-IR、TG、TC可能是影响IGR、DM患者胰腺脂肪沉积的高危因素。结论1.BMI、HOMA2-IR、TG、TC可能是影响IGR、T2DM患者胰腺脂肪沉积的高危因素。2.超声估测胰腺脂肪沉积具有可行性,为评价胰腺脂肪沉积提供一种方便、安全、无创的方法。背景糖尿病肾病(Diabetic Nephropathy,DN)是糖尿病常见的、严重的、预后较差的慢性并发症,属于糖尿病微血管病变,DN最终将发展到终末期肾病,因此近年来,DN的患病率居高不下,成为DM患者致死的主要原因之一[1]。目前,临床通常用尿微量白蛋白这一指标来诊断DN,当糖尿病肾病确诊时,肾脏损害已发生了不可逆改变。在m Alb出现前,DM患者的肾脏组织已呈现病理和血流灌注的变化。因此,寻找一种无创、安全、有效的检查方法来检测DN肾脏组织的血流灌注改变有较高的临床意义。目的1.采用超声造影(contrast-enhanced ultrasound,CEUS)定量分析技术检测早期DN肾脏组织血流灌注的改变。2.探讨CEUS定量分析技术对早期糖尿病肾病肾脏组织血流灌注评估的使用价值。为早期评估糖尿病肾病患者肾脏组织血流灌注改变,提供一种新的影像学检查方法。方法选取上海市第六人民医院东院2015年10月-2016年1月糖尿病流行病调查糖代谢紊乱者34名,其中糖调节受损10例(IGR组),早期糖尿病肾病24例(DN组,m Alb20-200mg/mmol),健康对照组(NC组)10人。测定受检者尿微量白蛋白(Urine trace albumin,m Alb)、尿微量白蛋白/尿肌酐(urine trace albumin/uric creatinine,m Alb/Cr)、血清肌酐(serum creatinine,Scr)、糖化血红蛋白(glycosylated hemoglobin,Hb A1c)、血尿酸(blood uric acid,BUA)、血尿素氮(blood urea nitrogen,BUN);应用MDRD公式:GFR(ml/min1.73m2)=186×(Scr)-1.154×(Age)-0.203×(0.742female),计算GFR,并做比较分析。使用PHILIPS i U Elit超声诊断仪,对44例受检者行超声常规检查双侧肾脏,随后采用团注法肘静脉注射声诺维(Sono Vue)超声造影剂1.2m1,观察动态双侧肾脏超声造影灌注成像。ROI定义为自由形状,QLAB(Philips)软件测定肾脏组织超声造影灌注(DTPM)参数,生成时间一强度曲线(time-intensity curve,TIC)灌注曲线,软件自动生出分析数值,包括曲线下面积(area under curve,AUC)、峰值强度(DPI)、曲线上升斜率(A)、达峰时间(TTP)。结果1.受检者基本参数比较:IGR组、DN组m Alb(P=0.00)、m Alb/Cr(P=0.01)、Hb A1c(P=0.00)、UA(P=0.03)高于对照组。2.肾脏组织灌注实时观察结果:经肘静脉采用团注法注射声诺维(Sono Vue)造影剂后,肾主动脉、段动脉、叶间动脉、肾皮质、肾髓质、肾窦依以上顺序强化。Sono Vue显影的强度达到峰值后,渐渐消退直至消失。在NC受检者,肾脏灌注Sono Vue后,示皮质区的回声强度高于髓质区;在IGR受检者,皮质区的回声强度高于髓质区。而在DN受检者,肾脏灌注Sono Vue后,皮质区回声强度低于髓质区;造影剂洗脱,其廓清以肾窦、肾髓质、肾皮质依次为续。3.肾脏组织定量灌注参数分析结果:DN组肾皮质、肾髓质AUC、DPI大于NC组、IGR组(P0.05)。IGR组肾皮质、肾髓质AUC、DPI与NC组相比,差别未见有统计学差异。结论1.CEUS技术可发现早期糖尿病肾病肾脏血流灌注的异常,能有效分析评价早期DN血流灌注的变化。2.CEUS技术在糖调节受损期未见肾脏组织血流灌注显著改变,CEUS技术在糖调节受损期未观察到肾脏组织血流灌注显著改变。
[Abstract]:BACKGROUND DM is a chronic epidemic metabolic disorder characterized by an increasing prevalence rate year by year and has become a major disease endangering human health. Pancreatic fat deposition greatly increases the risk of T2DM. In recent years, more and more attention has been paid to the correlation between pancreatic fat deposition and abnormal glucose metabolism. Repeated examinations were used to estimate pancreatic fat deposition in people with abnormal glucose metabolism, analyze the correlation between pancreatic fat deposition and various high-risk factors of diabetes mellitus, and take early preventive measures against various risk factors to further reduce pancreatic fat deposition rate, which can effectively reduce the prevalence of DM and delay the progress of diabetes. Methods A total of 294 people aged 45 to 65 years (58 2) with high risk of diabetes were screened for DM in the East Hospital of Shanghai Sixth People's Hospital from October 2015 to January 2016. Disease, abnormal liver and kidney function, various infections, other acute or chronic pancreatic diseases or tumors, splenic diseases, surgery or other stress conditions. Demographic data, current history, past history, anthropological parameters, biochemical parameters and pancreatic ultrasound were collected. Pancreatic fat deposition was estimated by using rectus abdominis as a reference. According to the echo, pancreatic fat deposition was divided into 1, 2, 3. 111 patients with DM were classified as DM group, 54 patients with impaired glucose metabolism were classified as IGR group and 129 healthy controls as control group. Results 1. 23 cases (17.8%) of pancreatic fat deposits were detected in healthy group, 16 cases (29.6%) in IGR group, 11 cases (11.6%) in grade 2 and 3, 34 cases (30.6%) in DM group, and 22 cases (12.3%) in grade 2 and 3 respectively (P 0.05). The detection rate of pancreatic fat deposition increased gradually with the progression of diabetes mellitus (c2 = 19.14, P 0.01). 2. TC (P = 0.01), TG (P = 0.01), LDL-C (P = 0.00), FPG (P = 0.00), HOMA2-IR (P = 0.03), HOMA-IS (P = 0.00) in IGR group, DN group was significantly higher than the control group. 3. BMI, HOMA2-IR, TG, TC may be the high risk factors of pancreatic fat deposition in DM patients. Background Diabetic nephropathy (DN) is a common, serious, and poor prognosis chronic complication of diabetes mellitus. In recent years, the prevalence of DN remains high, which is one of the main causes of death in DM patients [1].At present, microalbuminuria is commonly used as an indicator to diagnose DN. When diabetic nephropathy is diagnosed, renal damage has undergone irreversible changes. Before the appearance of Alb, the renal tissues of DM patients showed pathological and blood perfusion changes. Therefore, it is of great clinical significance to find a non-invasive, safe and effective method to detect the changes of renal blood perfusion in DN. Objective 1. To detect early DN kidney by contrast-enhanced ultrasound (CEUS) quantitative analysis technique. To explore the value of CEUS quantitative analysis technique in evaluating renal tissue perfusion in patients with early diabetic nephropathy. 34 patients with diabetes mellitus were investigated by epidemiological survey in January, 2001. Among them, 10 were impaired glucose regulation (IGR group), 24 were early diabetic nephropathy (DN group, m Alb 20-200mg/mmol), and 10 were healthy control group (NC group). Urine trace albumin (m Alb) and urine trace albumin/uric creatinine (m Alb) were measured. Alb/Cr, serum creatinine (Scr), glycosylated hemoglobin (Hb A1c), blood uric acid (BUA), blood urea nitrogen (BUN); MDRD formula: GFR (ml/min 1.73m2) = 186 * (Scr) - 1.154 * (Age) - 0.203 * (0.742 female), GFR was calculated and compared. Ultrasonography was performed in 44 patients with bilateral kidneys. Sono Vue was injected intravenously into the elbow with 1.2m1 contrast agent. Dynamic bilateral renal ultrasound perfusion imaging was observed. ROI was defined as free-form. The parameters of renal tissue contrast-enhanced ultrasound perfusion (DTPM) were measured by QLAB (Philips) software. The time of formation was one. Time-intensity curve (TIC) perfusion curve, software automatically generated analytical values, including area under curve (AUC), peak strength (DPI), curve rise slope (A), peak time (TTP). Results 1. Comparison of basic parameters: IGR group, DN group M Alb (P = 0.00), m Alb / Cr (P = 0.01), Hb A1c (P = 0.00), UA (P = 0.03) higher than the pair. Real-time observation of renal tissue perfusion: renal aorta, segmental artery, interlobar artery, renal cortex, renal medulla and renal sinus were enhanced in the above order after injection of Sono Vue into the elbow vein. The intensity of Sono Vue imaging reached the peak value and gradually disappeared until disappeared. The echo intensity in the cortex was higher than that in the medulla; in the IGR, the echo intensity in the cortex was higher than that in the medulla. There was no significant difference between IGR group and NC group in renal cortex, renal medulla AUC, DPI. Conclusion 1. CEUS technique can detect abnormal renal perfusion in early diabetic nephropathy, and can effectively analyze and evaluate the changes of early DN perfusion. 2. CEUS technique can not detect renal perfusion in impaired glucose regulation stage. There was no significant change in renal tissue perfusion during impaired glucose regulation by CEUS.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2
本文编号：2186753
[Abstract]:BACKGROUND DM is a chronic epidemic metabolic disorder characterized by an increasing prevalence rate year by year and has become a major disease endangering human health. Pancreatic fat deposition greatly increases the risk of T2DM. In recent years, more and more attention has been paid to the correlation between pancreatic fat deposition and abnormal glucose metabolism. Repeated examinations were used to estimate pancreatic fat deposition in people with abnormal glucose metabolism, analyze the correlation between pancreatic fat deposition and various high-risk factors of diabetes mellitus, and take early preventive measures against various risk factors to further reduce pancreatic fat deposition rate, which can effectively reduce the prevalence of DM and delay the progress of diabetes. Methods A total of 294 people aged 45 to 65 years (58 2) with high risk of diabetes were screened for DM in the East Hospital of Shanghai Sixth People's Hospital from October 2015 to January 2016. Disease, abnormal liver and kidney function, various infections, other acute or chronic pancreatic diseases or tumors, splenic diseases, surgery or other stress conditions. Demographic data, current history, past history, anthropological parameters, biochemical parameters and pancreatic ultrasound were collected. Pancreatic fat deposition was estimated by using rectus abdominis as a reference. According to the echo, pancreatic fat deposition was divided into 1, 2, 3. 111 patients with DM were classified as DM group, 54 patients with impaired glucose metabolism were classified as IGR group and 129 healthy controls as control group. Results 1. 23 cases (17.8%) of pancreatic fat deposits were detected in healthy group, 16 cases (29.6%) in IGR group, 11 cases (11.6%) in grade 2 and 3, 34 cases (30.6%) in DM group, and 22 cases (12.3%) in grade 2 and 3 respectively (P 0.05). The detection rate of pancreatic fat deposition increased gradually with the progression of diabetes mellitus (c2 = 19.14, P 0.01). 2. TC (P = 0.01), TG (P = 0.01), LDL-C (P = 0.00), FPG (P = 0.00), HOMA2-IR (P = 0.03), HOMA-IS (P = 0.00) in IGR group, DN group was significantly higher than the control group. 3. BMI, HOMA2-IR, TG, TC may be the high risk factors of pancreatic fat deposition in DM patients. Background Diabetic nephropathy (DN) is a common, serious, and poor prognosis chronic complication of diabetes mellitus. In recent years, the prevalence of DN remains high, which is one of the main causes of death in DM patients [1].At present, microalbuminuria is commonly used as an indicator to diagnose DN. When diabetic nephropathy is diagnosed, renal damage has undergone irreversible changes. Before the appearance of Alb, the renal tissues of DM patients showed pathological and blood perfusion changes. Therefore, it is of great clinical significance to find a non-invasive, safe and effective method to detect the changes of renal blood perfusion in DN. Objective 1. To detect early DN kidney by contrast-enhanced ultrasound (CEUS) quantitative analysis technique. To explore the value of CEUS quantitative analysis technique in evaluating renal tissue perfusion in patients with early diabetic nephropathy. 34 patients with diabetes mellitus were investigated by epidemiological survey in January, 2001. Among them, 10 were impaired glucose regulation (IGR group), 24 were early diabetic nephropathy (DN group, m Alb 20-200mg/mmol), and 10 were healthy control group (NC group). Urine trace albumin (m Alb) and urine trace albumin/uric creatinine (m Alb) were measured. Alb/Cr, serum creatinine (Scr), glycosylated hemoglobin (Hb A1c), blood uric acid (BUA), blood urea nitrogen (BUN); MDRD formula: GFR (ml/min 1.73m2) = 186 * (Scr) - 1.154 * (Age) - 0.203 * (0.742 female), GFR was calculated and compared. Ultrasonography was performed in 44 patients with bilateral kidneys. Sono Vue was injected intravenously into the elbow with 1.2m1 contrast agent. Dynamic bilateral renal ultrasound perfusion imaging was observed. ROI was defined as free-form. The parameters of renal tissue contrast-enhanced ultrasound perfusion (DTPM) were measured by QLAB (Philips) software. The time of formation was one. Time-intensity curve (TIC) perfusion curve, software automatically generated analytical values, including area under curve (AUC), peak strength (DPI), curve rise slope (A), peak time (TTP). Results 1. Comparison of basic parameters: IGR group, DN group M Alb (P = 0.00), m Alb / Cr (P = 0.01), Hb A1c (P = 0.00), UA (P = 0.03) higher than the pair. Real-time observation of renal tissue perfusion: renal aorta, segmental artery, interlobar artery, renal cortex, renal medulla and renal sinus were enhanced in the above order after injection of Sono Vue into the elbow vein. The intensity of Sono Vue imaging reached the peak value and gradually disappeared until disappeared. The echo intensity in the cortex was higher than that in the medulla; in the IGR, the echo intensity in the cortex was higher than that in the medulla. There was no significant difference between IGR group and NC group in renal cortex, renal medulla AUC, DPI. Conclusion 1. CEUS technique can detect abnormal renal perfusion in early diabetic nephropathy, and can effectively analyze and evaluate the changes of early DN perfusion. 2. CEUS technique can not detect renal perfusion in impaired glucose regulation stage. There was no significant change in renal tissue perfusion during impaired glucose regulation by CEUS.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2
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