摘要
目的:探索磁共振动脉自旋回波序列运用于糖尿病肾病不同分期中评价肾脏血流动力学受损的价值。方法:2016年12月-2017年10月,前瞻性纳入临床确诊的65名糖尿病肾病患者作为试验组,门诊纳入30名健康体检者作为对照组。根据肾小球滤过率将65名患者分为组1[n=32,e GFR>60 ml/(min·1.73 m^2)]、组2[n=18,60 ml/(min·1.73 m^2)≥e GFR>30 ml/(min·1.73 m^2)]、组3[n=15,e GFR≤30 ml/(min·1.73 m^2)]。所有患者均接受3.0T磁共振扫描,采用12通道相控阵线圈。结果:两位观察者测量肾脏血流量一致性高(ICC=0.87)。随着糖尿病肾病患者肾脏功能的降低,肾脏皮质肾血流量出现明显降低(F=23.66,P<0.05)。组1肾脏皮质血流量与对照组比较差异无统计学意义(P>0.05),组2、组3与对照组比较差异均有统计学意义(P<0.05)。糖尿病肾病肾脏皮质血流量与肾小球滤过率呈正相关关系(r=0.67,P<0.05)。ROC曲线分析,RBF阈值为178.34 ml/(min·100 g)时,区别糖尿病肾病正常肾脏功能(组1)与肾脏功能受损组(组2、组3)的敏感性、特异性分别为76%、82%。结论:磁共振动脉自旋回波序列可早期探测糖尿病肾病患者肾脏功能的损害,可作为无创评价糖尿病肾病的有效手段。
Objective：To explore whether arterial spin labeling（ASL） MRI could detect renal hemodynamic impairment in diabetes mellitus（DM） along different stages of chronic kidney disease.Method：From December 2016 to October 2017,we prospectively analyzed the data of 65 patients with clinically confirmed diabetic nephropathy（study group） and 30 out-patient volunteers without diabetes mellitus or any renal disease（control group）.Patients were classified according to their estimated glomerular filtration rate（e GFR） as group Ⅰ[n=32,e GFR60 ml/（min·1.73 m2）],group Ⅱ[n=18,60 ml/（min·1.73 m2）≥e GFR30 ml/（min·1.73 m2）],and group Ⅲ[n=15,e GFR≤30 ml/（min·1.73 m2）],to determine differences depending on renal function.Studies were performed at 3 T using a 12-channel body array coil as receiver.Result：The measurement of renal blood flow between the two observers was good（ICC=0.87）.A marked decrease in RBF was noted a long with progression of diabetic nephropathy（DN,F=23.66,P0.05）.There was no difference between group 1 and control group.However,differences were seen between group 2,group 3 and control group.Strong correlation（r=0.67,P0.05） was obtained between RBF and GFR.Using 178.34 ml/（min·100 g） as the cut-off value,the ADC index obtained a sensitivity of 76% and a specificity of 82% for predicting normal renal function of diabetic nephropathy（group 1） from renal function damage group（group 2 and group 3）.Conclusion：ASL-MRI is able to quantify early renal perfusion impairment in DM,and it can be used as an effective method for noninvasive evaluation of diabetic nephropathy.
作者
章娜
彭茜
黄晓佳
牛翔科
严宗逊
ZHANG Na,PENG Xi,HUANG Xiaojia(Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Chin)
出处
《中外医学研究》
2018年第12期4-7,共4页
CHINESE AND FOREIGN MEDICAL RESEARCH
关键词
糖尿病肾病
动脉自旋回波
磁共振成像
肾血流量
Diabetic nephropathy
Arterial spin labeling
Magnetic resonance imaging
Renal blood flow
