【摘要】：目的:利用磁共振擴(kuò)散峰度成像(diffusion kurtosis imaging,DKI)技術(shù),對糖尿病腎病患者及健康志愿者進(jìn)行腎臟磁共振擴(kuò)散峰度成像檢查,獲得平均峰度(mean kurtosis,MK)、徑向峰度(radial kurtosis,K⊥)、軸向峰度(axial kurtosis,K∥)的值以及相應(yīng)偽彩圖,探討不同時期糖尿病腎病患者腎臟皮髓質(zhì)MK值、K⊥值、K∥值的改變,分析其與腎功能指標(biāo)的相關(guān)性,以期對糖尿病腎病的診斷提供有效的影像學(xué)依據(jù)。方法:選擇臨床確診的糖尿病腎病患者12例為觀察組,根據(jù)尿白蛋白排泄率(urinary album in excretion rate,UAER)的結(jié)果分為DN早期組7例,DN晚期組5例,選擇健康志愿者11例為對照組,觀察組及對照組均在3.0T磁共振上進(jìn)行DKI檢查,擴(kuò)散梯度因子(b值)為(0 1000s/mm22000s/mm2),產(chǎn)生MK、K⊥、K∥的圖,對于每個受試者,在左腎和右腎的上極、腎門及下極區(qū)域繪制了共12個感興趣的區(qū)域(region of interest,ROI),皮質(zhì)、髓質(zhì)各6個,取其平均值,比較左腎及右腎皮質(zhì)、髓質(zhì)的MK值、K⊥值、K∥值的差異,并比較對照組與不同分期糖尿病腎病患者之間的皮質(zhì)、髓質(zhì)的MK值、K⊥值、K∥值有何不同,繪制ROC曲線,分析皮質(zhì)MK值在對照組與DN早期組、DN早期組與DN晚期組的診斷靈敏度與特異度,分析各測量值與24小時尿白蛋白之間的相關(guān)性。結(jié)果:對照組及不同糖尿病腎病患者左腎的皮髓質(zhì)測量值與右腎的皮髓質(zhì)測量值均無統(tǒng)計學(xué)差異;隨著疾病的進(jìn)展,皮質(zhì)與髓質(zhì)的MK、K∥、K⊥值逐漸升高,且皮質(zhì)測量值的差異具有統(tǒng)計學(xué)意義;相鄰兩組間比較,對照組皮質(zhì)的MK、K∥、K⊥值均低于DN早期組(p0.05),DN早期組的MK、K⊥值低于DN晚期組(p0.05),相鄰兩組之間髓質(zhì)的測量值未觀察到明顯差異;皮質(zhì)的MK值在對照組與DN早期組、DN早期組與DN晚期組的診斷中準(zhǔn)確性較高(AUC0.8);皮質(zhì)的MK、K∥、K⊥值與UAER呈正相關(guān),髓質(zhì)的測量值無明顯相關(guān)性。結(jié)論:(1)DKI技術(shù)在糖尿病腎病檢查具有可行性。(2)DKI的皮質(zhì)的MK值可以發(fā)現(xiàn)糖尿病腎病的早期損害,對于糖尿病腎病的分期具有一定參考意義。(3)糖尿病腎病患者皮質(zhì)的MK、K∥、K⊥值與UAER具有顯著相關(guān)性,可以監(jiān)測糖尿病腎病的進(jìn)展情況。
[Abstract]:Objective: to study the renal diffusion-kurtosis imaging of patients with diabetic nephropathy (DN) and healthy volunteers by using (diffusion kurtosis imaging (DKI) technique. The values of mean kurtosis (MK), radial kurtosis (radial kurtosisK) and axial kurtosisK (axial kurtosisK) were obtained, and the corresponding pseudochromograms were obtained. In order to provide effective imaging evidence for the diagnosis of diabetic nephropathy, the correlation between renal function and renal function was analyzed. Methods: twelve patients with diabetic nephropathy were selected as observation group. According to the results of urinary albumin excretion rate (urinary album in excretion), they were divided into early DN group (n = 7), early DN group (n = 7) and healthy volunteers (n = 11) as control group. DKI was performed on 3.0T MRI in both the observation group and the control group. The diffusion gradient factor (b) was (0 1000s/mm22000s/mm2), which produced a map of MKK ~ (?) K /. For each of the subjects, the upper pole of the left and right kidneys was obtained. A total of 12 regions of interest (region of interesting ROI), cortical and medullary were drawn from the hilar region and the lower pole region. The mean values of MK in the left kidney and the right renal cortex were compared between the left kidney and the right renal cortex, and the difference of the MK value of the medulla and that of the medulla was compared. To compare the difference of MK value of medulla between the control group and the patients with different stages of diabetic nephropathy, draw the ROC curve. The diagnostic sensitivity and specificity of cortex MK in control group, early DN group and late DN group were analyzed, and the correlation between the measured values and 24 hour urinary albumin was analyzed. Results: there was no significant difference between the measured values of left kidney and right kidney in control group and patients with different diabetic nephropathy. The differences of cortical measurements were statistically significant. In the control group, the value of MKK _ (K) in the cortex was lower than that in the early DN group (p0.05) and the value of MK _ (K) in the early DN group was lower than that in the late DN group (p0.05). There was no significant difference in medullary measurement between the two adjacent groups. The diagnostic accuracy of MK value in cortex was higher than that in early DN group and early DN group (AUC0.8), and the MKK / K Karabakh value of cortex was positively correlated with UAER, but there was no significant correlation between medullary measurement value and cortex MK value in early DN group and late DN group (AUC0.8). Conclusion: (1) DKI technique is feasible in the detection of diabetic nephropathy. (2) the MK value of the cortex of DKI can be used to detect the early damage of diabetic nephropathy. (3) there is a significant correlation between the value of MKK / K and UAER in the cortex of patients with diabetic nephropathy, which can be used to monitor the progress of diabetic nephropathy.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.2;R692.9;R445.2

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