目的 探讨超声造影技术在糖尿病肾脏疾病(DKD)早期鉴别诊断中的临床价值.方法 收集2021年8月到2022年10月在北京空军特色医学中心住院的慢性肾脏病(CKD)患者临床资料,包括CKD病因、超声参数以及实验室指标等,将患者分为非DKD组和DKD组,比较两组患者超声参数差异并与临床指标进行相关性分析.结果 DKD组肾门动脉阻力指数(RI)(0.72±0.08)高于非 DKD 组(0.66±0.07)(t=-3.52,P＜0.001),段动脉 RI(0.67±0.06)高于非DKD组(0.62±0.07)(t=-2.93,P=0.005),造影剂达峰时间(TTP)[(23.37±6.68)s]长于非 DKD组[(19.57±7.81)s](t=-2.14,P=0.036).而叶间动脉RI和造影参数到达肾皮质时间(AT)、曲线上升支斜率(AS)、峰值强度(PI)、曲线下降支斜率(DS)、曲线下面积(AUC)、平均通过时间(MTT)差异无统计学意义(P＞0.05).估算肾小球滤过率(eGFR)≥60 mL/(min·1.73 m2)期间,DKD 组肾门动脉(0.70±0.08)、段动脉(0.65±0.06)、叶间动脉(0.61±0.05)的 RI 明显较非 DKD组肾门动脉(0.62±0.10)(t=-3.30,P＜0.01),段动脉(0.59±0.05)(t=-3.29,P＜0.01),叶间动脉(0.56±0.04)(t=-3.05,P＜0.01)的 RI 升高,DKD组的 TTP[(23.67±3.75)s]也明显较非 DKD组[(18.80±7.10)s](t=-2.54,P＜0.05)延长;eGFR＜60 mU(min·1.73 m2)期间,与非DKD组比较,DKD组的肾门动脉RI(0.75±0.06)升高(t=-2.74,P＜0.01),但段动脉RI、叶间动脉RI、TTP差异无统计学意义(P＞0.05).结论 超声造影参数TTP联合叶间动脉、段动脉、肾门动脉RI对糖尿病肾脏疾病的早期鉴别诊断具有一定的临床价值.
Objective To investigate the clinical value of contrast-enhanced ultrasound(CEUS)in the early differential diagnosis of diabetic kidney disease(DKD).Methods The clinical data of patients with chronic kidney disease(CKD)hospitalized in Beijing Air Force Medical Center from August 2021 to October 2022 were collected,including the etiology of CKD,ultrasound parameters and laboratory biochemical indicators.The patients were divided into non-DKD group and DKD group.The differences in ultrasound parameters between the two groups were compared and their correlation with clinical indicators were analyze.Results The resistance index(RI)of renal portal artery in DKD group(0.72±0.08)was higher than that in non-DKD group(0.66±0.07)(t=-3.52,P＜0.001),the RI of segmental artery in DKD group(0.67± 0.06)was higher than that in non-DKD group(0.62±0.07)(t=-2.93,P=0.005),and the time to peak(TTP)[(23.37±6.68)s]of contrast medium was longer than that in non-DKD group[(19.57±7.81)s](t=-2.14,P=0.036),while there were no statistically significant differences in RI of interlobar artery and contrast parameters such as arrival time(AT),ascending slope(AS),peak intensity(PI),descending slope(DS),area under curve(AUC)and mean transit time(MTT)(P＞0.05).During the period of eGFR≥60 mU(min·1.73 m2),the RI of renal portal artery(0.70±0.08),segmental artery(0.65±0.06)and interlobar artery(0.61±0.05)in DKD group was significantly higher than that in non-DKD group[(0.62±0.10)(t=-3.30,P＜0.01),(0.59±0.05)(t=-3.29,P＜0.01),(0.56±0.04)(t=-3.05,P＜0.01)].The TTP in DKD group[(23.67±3.75)s]was also significantly longer than that in non-DKD group[(18.80±7.10)s](t=-2.54,P＜0.05).During the period of eGFR＜60 mL/(min·1.73m2),compared with non-DKD group,the RI of renal portal artery in DKD group(0.75±0.06)was higher(t=-2.74,P＜0.01),but there were no differences in RI of segmental artery,RI of interlobar artery,or TTP.Conclusions The TTP combined with RI of segmental artery,interlobar artery,and renal portal artery in CEUS has certain clinical value in the early differential diagnosis of diabetic kidney disease.
凌晓晶;李玥铭;刘东;范校周;高卓;余颖;谷君辉;单婧;崔瑜;吕小萌;邱德俊
空军特色医学中心肾脏病科,北京 100142||中国医科大学,辽宁沈阳 110031空军特色医学中心肾脏病科,北京 100142
临床医学
糖尿病性肾脏疾病;慢性肾脏病;超声造影;肾功能
diabetic kidney disease;chronic kidney disease;contrast-enhanced ultrasound;renal function
《中国实用内科杂志》 2024 (003)
204-209 / 6
国家军用标准研究项目(BKJ20B047);空军特色医学中心科技助推课题(2022ZTYB46);空军特色医学中心临床研究项目(2021LC006)
10.19538/j.nk2024030106
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