發(fā)布時間：2018-02-16 03:53

  本文關(guān)鍵詞： 糖尿病 腎臟病變 超聲造影 聲觸診組織定量 尿白蛋白排泄率　出處：《華北理工大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的本研究通過超聲造影(contrast-enhanced ultrasound,CEUS)定量分析技術(shù)及聲觸診組織定量技術(shù)(virtual touch quantification,VTQ)檢查對照組及2型糖尿病患者腎臟血流灌注及腎組織彈性情況,分析相關(guān)參數(shù),并對2型糖尿病腎臟病變患者CEUS及VTQ的相應(yīng)超聲指標(biāo)與尿白蛋白排泄率(urinary albumin excretion rate,UAER)之間進(jìn)行單因素及多因素分析,探索糖尿病腎臟病變(diabetic kidney disease,DKD)早期改變的無創(chuàng)超聲影像學(xué)指標(biāo),以便對臨床的早期診斷及治療提供更多影像學(xué)信息。方法依據(jù)1999年WHO糖尿病診斷標(biāo)準(zhǔn)選取唐山市工人醫(yī)院內(nèi)分泌科2013年12月~2014年12月住院的2型糖尿病(type 2 diabetes mellitus,T2DM)患者90例(男性47例,女性43例,年齡范圍28~68歲,平均年齡52.03±11.08歲)。并按性別、年齡匹配同期選擇對照組30例(男15例,女15例,年齡30~68歲,平均51.37±9.59歲)。依據(jù)Mogensen分期,以UAER作為評價指標(biāo),將糖尿病患者分為3組:正常白蛋白尿組(A組)、微量白蛋白尿組(B組)及臨床蛋白尿組(C組)。采用Philips i U 22及Siemens S2000彩色多普勒超聲診斷儀對所有研究對象分別進(jìn)行CEUS及VTQ檢查,測量反映腎臟血流灌注的超聲造影定量參數(shù),包括曲線上升時間(rise time,RT)、曲線下面積(area under curve,AUC)、曲線達(dá)峰絕對值(derived peak intensity,DPI)、曲線達(dá)峰時間(time to peak,TTP)和濃度降半時間(Time from peak to one half);測量反映腎組織彈性順應(yīng)力的的橫向剪切波速度(shear wave velocity,Vs)。對所有研究對象記錄一般臨床資料(身高、體重、血壓等)及相關(guān)實(shí)驗(yàn)室檢查,主要包括:24h尿白蛋白排泄率(UAER)、血清總膽固醇(TC)、高密度脂蛋白(HDL-C)、甘油三酯(TG)、糖化血紅蛋白(Hb Alc)、低密度脂蛋白(LDL-C)及空腹血糖(FBG)。所有數(shù)據(jù)分析應(yīng)用SPSS19.0統(tǒng)計軟件包進(jìn)行統(tǒng)計分析,計量資料的正態(tài)性檢驗(yàn)用K-S擬合優(yōu)度檢驗(yàn),正態(tài)分布的計量資料用均數(shù)±標(biāo)準(zhǔn)差(x±s)表示,多組數(shù)據(jù)間比較用one-way ANOVA,經(jīng)Levene方差齊性檢驗(yàn),方差齊時組間比較采用LSD法,方差不齊時采用Dunnett’s T3法;計數(shù)資料用百分率表示,采用行×列的卡方檢驗(yàn)進(jìn)行組間率的比較。分析UAER與腎皮質(zhì)血流灌注參數(shù)、腎實(shí)質(zhì)及腎竇部Vs的相關(guān)性,并計算相關(guān)系數(shù)。采用多因素非條件Logistic回歸分析DKD的影響因素,并采用ROC曲線圖,結(jié)合靈敏度及特異度取最大切點(diǎn)值,估測相關(guān)指標(biāo)評估早期DKD的界值。檢驗(yàn)水準(zhǔn):P0.05表示差異有統(tǒng)計學(xué)意義。結(jié)果1 3組糖尿病患者與對照組在性別、年齡、TG、HDL-C、TC、LDL-C、SBP、DBP、BMI之間差異均無統(tǒng)計學(xué)意義(P0.05),有無糖尿病家族史之間差異有統(tǒng)計學(xué)意義(P0.01)。3組糖尿病患者間病程、FBG、Hb Alc兩兩比較,C組的糖尿病病程、FBG及Hb Alc均高于A組、B組,差異有統(tǒng)計學(xué)意義(P0.01),A組與B組之間差異無統(tǒng)計學(xué)意義。2 CEUS能夠清晰地顯示造影劑在腎臟灌注的整個過程。3組糖尿病患者及對照組各組內(nèi)左、右側(cè)腎臟CEUS相關(guān)參數(shù)之間差異均無統(tǒng)計學(xué)意義(P0.05)。對照組、A組、B組及C組比較,DPI依次減小,組間差異具有統(tǒng)計學(xué)意義(P0.01);與對照組比較,A組、B組患者AUC明顯增高,C組患者AUC明顯降低,差異均具有顯著統(tǒng)計學(xué)意義(P0.01);B組、C組患者TTP、RT較對照組明顯延長(P0.05),A組患者與對照組差異無統(tǒng)計學(xué)意義(P0.05);A組、B組、對照組間兩兩比較濃度降半時間差異無統(tǒng)計學(xué)意義,C組與對照組比較濃度降半時間明顯延長,組間差異具有統(tǒng)計學(xué)意義(P0.05)。3 3組糖尿病患者及對照組各組內(nèi)左、右側(cè)腎臟的腎實(shí)質(zhì)Vs之間;左、右側(cè)腎臟的腎竇部Vs之間分別比較,差異均無統(tǒng)計學(xué)意義(P0.05)。所有研究對象腎臟腎實(shí)質(zhì)Vs腎竇部Vs,差異有統(tǒng)計學(xué)意義(P0.01)。與對照組比,C組患者腎實(shí)質(zhì)Vs低于對照組,差異具有統(tǒng)計學(xué)意義(P=0.020.05),C組腎竇部Vs與對照組比較差異無統(tǒng)計學(xué)意義(P0.05)。A組、B組的腎實(shí)質(zhì)、腎竇部Vs分別與對照組比較,差異無統(tǒng)計學(xué)意義(P0.05)。3組糖尿病患者之間兩兩比較,A組、B組患者腎實(shí)質(zhì)Vs高于C組患者腎實(shí)質(zhì)Vs,差異具有統(tǒng)計學(xué)意義(P0.05);A組、B組患者腎實(shí)質(zhì)Vs之間差異無統(tǒng)計學(xué)意義(P0.05)。A組、B組、C組3組之間腎竇部Vs差異均無統(tǒng)計學(xué)意義(P0.05)。4經(jīng)Spearman相關(guān)性分析,UAER與RT、TTP及濃度降半時間呈明顯正相關(guān)(P0.01),與DPI及腎實(shí)質(zhì)Vs呈明顯負(fù)相關(guān)(P0.01),與腎竇部Vs無明顯相關(guān)性(P0.05)。5以UAER是否異常為因變量,對觀察指標(biāo)進(jìn)行多因素非條件Logistic回歸分析結(jié)果顯示:空腹血糖、糖尿病病程、Hb A1C、家族糖尿病、喜葷食及RT、DPI是UAER出現(xiàn)異常的危險因素,即出現(xiàn)早期DKD的危險性增加;根據(jù)ROC曲線,選取RT、DPI界值分別在15.94s、13.53d B時,其在評估早期DN的靈敏度分別為81.8%、68.2%,特異度分別為80.4%、87.0%,而且RT與DPI之間具有較好的一致性,當(dāng)RT與DPI并聯(lián)組合時,其靈敏度和特異度分別為88.6%、78.3%。結(jié)論1 CEUS技術(shù)能夠分析DKD患者血流灌注參數(shù)的改變,DKD早期RT、AUC、DPI及TTP已出現(xiàn)異常,可以作為評估DKD患者早期腎功能異常的重要指標(biāo)。2UAER與腎皮質(zhì)血流灌注參數(shù)RT、TTP、濃度降半時間呈明顯正相關(guān),與DPI呈明顯負(fù)相關(guān),隨著病情加重,RT、TTP及濃度降半時間越來越長,DPI降低。3 RT、DPI值在一定程度上能夠較準(zhǔn)確地判斷早期DKD腎臟損害程度,為DKD早期診斷提供新的參考依據(jù)。4 VTQ技術(shù)測量Vs值可以量化評估DKD患者腎臟彈性,腎實(shí)質(zhì)區(qū)腎竇區(qū),且腎實(shí)質(zhì)區(qū)的Vs值與患者腎損害程度呈明顯負(fù)相關(guān),隨著腎損害的加重,Vs值越低,為DKD患者的診斷提供一種新的無創(chuàng)的定量評估指標(biāo)。
[Abstract]:The purpose of this study by contrast enhanced ultrasound (contrast-enhanced ultrasound, CEUS) quantitative analysis technology and virtual touch tissue quantification (virtual touch, quantification, VTQ) to check the control group and patients with type 2 diabetes mellitus renal blood perfusion and renal tissue elasticity, analysis of related parameters, the corresponding ultrasonic index and urinary albumin excretion in type 2 diabetes and kidney disease patients with CEUS and VTQ (urinary albumin excretion rate rate, UAER) between single factor and multiple factor analysis, to explore the diabetic nephropathy (diabetic kidney, disease, DKD) noninvasive ultrasound imaging index in the early period of change, so that the clinical early diagnosis and treatment to provide more imaging information. According to the 1999 WHO diabetes diagnostic criteria for selection of Tangshan City workers' Hospital Department of endocrinology in December 2013 December ~2014 diagnosed type 2 diabetes (type diabetes 2 mellitus, T2DM) patients In 90 cases (male 47 cases, female 43 cases, age range 28~68 years, mean age 52.03 + 11.08 years). According to gender, age, and selected 30 cases of the control group (male 15 cases, female 15 cases, age 30~68 years old, average 51.37 + 9.59 years). According to Mogensen staging, UAER as the evaluation index, the diabetic patients were divided into 3 groups: normal albuminuria group (group A), microalbuminuria group (group B) and clinical albuminuria group (group C). Using Philips I U 22 and Siemens S2000 color Doppler ultrasonic diagnostic apparatus for all subjects were performed CEUS and VTQ examination, measurement of reflection quantitative parameters of contrast-enhanced ultrasound of renal blood perfusion, including the curve rise time (rise time, RT), the area under the curve (area under, curve, AUC), the curve of peak absolute value (derived peak intensity, DPI), curve peak time (time to, peak, TTP) and the concentration of half time (Time from peak to one half); measuring reflection The transverse shear wave velocity of renal tissue elastic compliance of the (shear wave velocity, Vs). The clinical data records for all subjects (height, weight, blood pressure, etc.) and related laboratory tests, including: 24h urinary albumin excretion rate (UAER), serum total cholesterol (TC), high density lipoprotein protein (HDL-C), triglyceride (TG), glycosylated hemoglobin (Hb Alc), low density lipoprotein (LDL-C) and fasting blood glucose (FBG). All data were analyzed using the SPSS19.0 statistical software package for statistical analysis, using K-S goodness-of-fit test measurement data normality test, standard deviation measurement the data of normal distribution (x + s) said that many sets of data were compared with one-way ANOVA, the Levene homogeneity of variance test, variance between groups when compared with LSD method, the variance not neat using Dunnett s T3 method; count data expressed as a percentage, chi square test for X column between groups The rate of UAER. The comparison with the renal cortex blood perfusion parameters, correlation between renal parenchyma and renal sinus Vs, the correlation coefficient is calculated. By multi factor non conditional Logistic regression analysis the influencing factors of DKD, and the ROC curve, combined with the sensitivity and specificity of the maximum cut-off value, estimate the evaluation of early DKD boundary value. Inspection level: P0.05 said the difference was statistically significant. The results of 13 groups of diabetic patients and control groups in gender, age, TG, HDL-C, TC, LDL-C, SBP, DBP, BMI were no significant differences between (P0.05), the difference between no family history of diabetes was statistically significant (P0.01.3) group of patients between the course of disease, FBG, Hb 22 Alc, duration of diabetes group C, FBG and Hb Alc were higher than A group, B group, the difference was statistically significant (P0.01), A group and B group had no significant difference.2 CEUS can clearly display the contrast agent in the kidney The whole process of.3 perfusion in patients with diabetes mellitus group and control group in each group left, the difference between the right kidney CEUS related parameters were not statistically significant (P0.05). The control group, A group, B group and C group, DPI decreased, the difference was statistically significant (P0.01); compared with the control group, A group B, AUC groups were significantly higher in C group, AUC decreased significantly, the difference was statistically significant (P0.01); B group, C group TTP, RT was significantly longer than that of the control group (P0.05), the A group and the control group had no significant difference (P0.05); A group, B group, control comparison between the 22 groups was half time was no significant difference between C group and control group the concentration of half time was prolonged, the differences between groups was statistically significant (P0.05.3) 3 groups of diabetic patients and control groups in the left and right renal parenchyma between Vs; left between kidney antrum the right of Vs respectively. 杈，

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