实时剪切波弹性成像技术在糖尿病肾病患者肾功能评估中的临床价值分析

doi:10.3969/j.issn.1006-5253.2020.03.003

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摘要目的探讨实时剪切波弹性成像(shear wave elastography，SWE)技术在糖尿病肾病(diabetic kidney disease，DKD)患者肾功能评估口的临床价值，为DKD的早期诊断、临庆治疗提供依据。方法收集某院2016年6月至2019年5月DKD患者62例及肾功能正常考14例，DKD患者早期肾病组、末肾病组及尿毒症组分别为21例、24例和17例。所有入组对象均行常规超声、SWE检查、9Tc-DTPA动态显像，分析各组患者问常规超声参数与平均杨氏模量值(Emam)、肾小玩滤过率(glomerular filtration rate,GFR)的差异，根据散点分布图将GFR与E进行非线性关系拟合并建立方程。结果常规超声参数(长度、皮质厚度、体积)各组问比较差异无统计学意义(P>0.05)。SWE参数左肾、右肾及双肾平均E值在DKD各亚组中呈逐渐升高趋势，与对照组比较差异均具有统计学意义(P<0.05)；DKD各亚组中，尿毒症组最高，早期肾病组最低，DKD各亚组间比较差异均具有统计学意义(P<0.05)。DKD各亚组总体GFR水平均降低，与对照组比较差异均具有统计学意义(P<0.01)。随着放射性标记的总CFR水平降低，平均E值呈逐渐升高趋势，进行Growth曲线拟合建立方程E(Y)=exp(5.789-0.417X)(P<0.001)，拟合效果好(R2=0.918)。E阔值为3.53 kPa时诊断早期肾病的灵敏度、特异度为77.4%、83.1%，阅值为4.49 kPa时诊断临床肾病的灵敏度、特异度为80.8%、90.2%，阅值为5.47 kPa时诊断尿毒症的灵敏度、特异度为83.5%、92.6%。结论 SWE在诊断DKD肾功能损害中具有较高的诊断效能，对于DKD的早期诊断、治疗具有重要临床意义。

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	裘思英
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关键词 ：剪切波弹性成像, 糖尿病肾病, 99mTc-DTPA肾动态显像

Abstract：

Objective To investigate the clinical value of ultrasound real-time shear wave elastography (SWE) in evaluating renal function in patients with diabetic kidney disease (DKD), and thus to provide evidence for elary diagnosis and clinical treatment of DKD. Methods Sixty-two patients with DKD and 14 cases with normal renal function were collected from June 2016 to May 2019.There were 21,24 and 17 cases in the early nephropathy,clinical nephropathy and uremia groups among the DKD patients,respectively.All subjects received conventional ultrasound,SWE and^99mTc-DTPA renal dynamic imaging examination. The differences of conventional ultrasound parameters,mean Young′s modulus E_mean) and glomerular filtration rate (GFR) were analyzed. The nonlinear relationship between GFR and E_meanwas fitted according to the scatter diagram, and the quation was established.Results There was no significant difference in conventional ultrasound parameters (length, physical evidence, volume) between steps groups (P >0.05). SWE parameters-E_meanwas gradually increased in left kidney, right kidney and both kidneys from the early nephropathy group (lowest) to the uremia group (highest), and the difference was statisticalally significant compared with the control group (P <0.05). Among the subgroups of DKD,the uremia group was the highest,and the early nephropathy group was the lowest, and the difference between each DKD subgroup was statistically significant (P <0.05). The level of total GFR in each DKD subgroup decreased, and the difference was statistically significant, compared with that in the control group (P <0.01). As the total GFR level of radiolabels decreases,the average E_meanvalue gradually increases. Growth curve fitting was made to establish the equation E (Y)=exp (5.789-0.417X)(P <0.001), and the fitting effect was good (R²=0.918). The sensitivity ands pecificity were 77.4% and 83.1% while E_meanthreshold was 3.53 kPa in the early stage group,sensitivity and specificity were 80.8% and 90.2 while E_meanthreshold was 4.49 kPa in the clinical nephropathy group,and sensitivity and specificity were 83.5% and 92.6% while E_mean threshold was 5.47 kPa in the uremia group,respectively.Conclusion SWE possesses high diagnostic efficiency in the diagnosis of renal dysfunction in DKD,which has important clinical significance in the early diagnosis and treatment of DKD.

Key words： shear wave elastography diabetic kidney disease ^99mTc-DTPA dynamic renography

收稿日期: 2020-03-26

通讯作者: 裘思英，Email:pan0586@126.com

引用本文:

裘思英，姜泽雯，吴赤球，陈多多. 实时剪切波弹性成像技术在糖尿病肾病患者肾功能评估中的临床价值分析[J]. 中国医院统计, 2020, 27(3): 202-206.
Qiu Siying，Jiang Zewen，Wu Chiqiu，Chen Duoduo. Clinical value of real-time shear wave elastography in evaluating renal function in patients with diabetic kidney disease. journal1, 2020, 27(3): 202-206.

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http://manu58.magtech.com.cn/Jwk_zgyytj/CN/10.3969/j.issn.1006-5253.2020.03.003 或 http://manu58.magtech.com.cn/Jwk_zgyytj/CN/Y2020/V27/I3/202

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