本文選題：腎皮質(zhì)　切入點：腎髓質(zhì)　出處：《蘇州大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的： 探討血氧水平依賴磁共振成像評價糖尿病腎病(diabetic nephropathy, DN)的臨床應用價值。 材料與方法： 研究11例健康志愿者,19例早期糖尿病腎病患者(eGFR60ml/min/1.73m2,伴微量或大量蛋白尿),15例中晚期糖尿病腎病患者(eGFR≤60ml/min/1.73m2,伴大量蛋白尿)。采用Siemens Magnetom Verio3.0T磁共振進行BOLD序列掃描,分別測量、計算三組患者雙腎的皮、髓質(zhì)R2*值及髓質(zhì)/皮質(zhì)R2*比值。采用單因素方差分析(ANOVA)進行組間兩兩比較。用ROC曲線分析診斷效能。采用Peason法分別將皮、髓質(zhì)的R2*值及髓質(zhì)/皮質(zhì)R2*比值與臨床指標(估算腎小球濾過率eGFR、糖化血紅蛋白HbA1c)進行相關(guān)性分析。 結(jié)果： 1)T2*偽彩圖上,正常對照組皮質(zhì)呈條片狀藍色,而糖尿病腎病皮質(zhì)呈彌漫藍點狀改變,早期DN組占63.2%(12/19),中晚期DN組占66.7%(10/15)。 2)正常對照組與早期DN組之間髓質(zhì)R2*具有顯著統(tǒng)計學差異(P0.01),具有診斷效能(P0.01),閾值為33.88s-1,敏感度及特異度分別為94.74%和90.91%。 3)早期DN組與中晚期DN組之間皮質(zhì)R2*及髓質(zhì)/皮質(zhì)R2*比值具有顯著統(tǒng)計學差異(P0.01),其中皮質(zhì)R2*值具有更高的診斷效能(P0.01),閾值為17.63S-1,敏感度與特異度分別為80%和84.21%。 4)正常對照組與中晚期DN組之間皮質(zhì)R2*及髓質(zhì)/皮質(zhì)R2*比值具有統(tǒng)計學差異(P0.05),其中皮質(zhì)具有診斷效能(P0.01),閾值為16.86s-1,敏感度和特異度分別在93.33%和100%。髓質(zhì)/皮質(zhì)R2*比值沒有診斷效能(P0.05)。 5)皮質(zhì)R2*值與eGFR呈負相關(guān)(r=-0.492,P0.01),髓質(zhì)/皮質(zhì)R2*比值與eGFR呈正相關(guān)(r=0.423,P0.05)。皮質(zhì)R2*值、髓質(zhì)R2*值及髓質(zhì)/皮質(zhì)R2*比值均與HbA1c無相關(guān)性。 結(jié)論： 1)糖尿病腎病T2*偽彩圖皮質(zhì)彌漫藍點狀改變具有一定的特征性。 2) BOLD-MRI可用于糖尿病腎病的診斷與分期。本研究中髓質(zhì)R2*值可用于鑒別正常組及早期DN組,皮質(zhì)R2*值可用于鑒別早期DN組與中晚期DN組以及正常組與中晚期DN組。 3)皮質(zhì)R2*值與eGFR呈負相關(guān),髓質(zhì)/皮質(zhì)R2*比值與eGFR呈正相關(guān),可用于檢測糖尿病腎病進展情況。
[Abstract]:Objective:. To evaluate the clinical value of blood oxygen level dependent magnetic resonance imaging (MRI) in the evaluation of diabetic nephropathy (DNs). Materials and methods:. Eleven healthy volunteers were studied in 19 patients with early diabetic nephropathy, 19 patients with early diabetic nephropathy, 19 patients with early diabetic nephropathy, 15 patients with moderate or advanced diabetic nephropathy with microalbuminuria, 15 patients with middle and late stage diabetic nephropathy, and 15 patients with advanced diabetic nephropathy, with large proteinuria. Siemens Magnetom Verio3.0T magnetic resonance imaging (Siemens Magnetom Verio3.0T) was used to perform BOLD sequence scanning, respectively. The skin and medullary R2 * values and medullary / cortical R2 * ratio of the three groups were calculated. The results were compared by single factor variance analysis (ANOVA). The diagnostic efficacy was analyzed by ROC curve. The skin was divided into two groups by Peason method. The R2 * value of medulla and the ratio of medullary / cortical R2 * were correlated with clinical indexes (estimated glomerular filtration rate (GFR) HbA1c). Results:. On the pseudochromatic images of T2 *, the cortex of normal control group was striped blue, while the cortex of diabetic nephropathy showed diffuse blue dot changes. The early DN group accounted for 63.2% and the middle and late DN group accounted for 66.7% of 15%. 2) there was significant difference in medullary R2 * between the normal control group and the early DN group (P 0.01), the diagnostic efficacy was P 0.01, the threshold value was 33.88 s-1.The sensitivity and specificity were 94.74% and 90.91 respectively. 3) the cortical R2 * and the ratio of medullary / cortical R2 * were significantly different between the early DN group and the middle and late DN group. The cortical R2 * value had higher diagnostic efficacy (P 0.01), the threshold value was 17.63 S-1, the sensitivity and specificity were 80% and 84.21, respectively. 4) the cortical R2 * and the ratio of medullary / cortical R2 * were significantly different between the normal control group and the advanced DN group (P 0.05), in which the cortex had diagnostic efficacy (P 0.01), the threshold value was 16.86s-1, the sensitivity and specificity were 93.33% and 100g, respectively. The medullary / cortical R2 * ratio had no diagnostic efficacy (P0.05). 5) the cortical R2 * value was negatively correlated with eGFR and the ratio of medullary / cortical R2 * was positively correlated with eGFR. The cortical R2 * value, medullary R2 * value and medullary / cortical R2 * ratio were not correlated with HbA1c. Conclusion:. 1) the diffuse blue dot change of T 2 * pseudochromogram in diabetic nephropathy is characteristic. 2) BOLD-MRI can be used in the diagnosis and staging of diabetic nephropathy. In this study, the medullary R2 * value can be used to differentiate normal group from early DN group, and cortical R2 * value to differentiate early DN group from middle and late DN group and normal group from late DN group. 3) the cortical R2 * value was negatively correlated with eGFR, and the medullary / cortical R2 * ratio was positively correlated with eGFR, which could be used to detect the progression of diabetic nephropathy.
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R587.2;R445.2

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