本文關(guān)鍵詞： 慢性腎臟病 磁共振成像 擴散張量成像 ADC值 FA值 腎小球濾過率　出處：《南昌大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的：應(yīng)用磁共振擴散張量成像技術(shù)（DTI）對健康志愿者及各期CKD患者的腎臟進行觀察和測量，研究磁共振擴散張量成像在CKD的應(yīng)用，分析CKD患者腎臟皮髓質(zhì)ADC值及FA值的改變，分析其與腎功能指標及CKD分期的相關(guān)性。探討DTI在慢性腎臟病中的應(yīng)用價值。 對象和方法：搜集南昌大學第一附屬醫(yī)院腎內(nèi)科收治的42例慢性腎臟病患者，測量血清肌酐水平(Scr)，，根據(jù)簡化腎臟病膳食改善（MDRD）方程計算腎小球濾過率估算值（eGFR），并根據(jù)eGFR確定CKD分期。搜集20例正常志愿者作為對照組。在1.5T MRI設(shè)備上行MRI彌散張量成像檢查（b=0，600s/mm2），測量腎臟皮髓質(zhì)ADC值和FA值，并行髓質(zhì)纖維束成像。比較各組腎臟皮質(zhì)、髓質(zhì)的ADC值和FA值的差異，并比較對照組與不同分期慢性腎臟病患者之間的皮質(zhì)、髓質(zhì)的ADC值和FA值的差異，繪制ROC曲線，比較腎皮質(zhì)ADC值和髓質(zhì)FA值鑒別對照組與不同分期慢性腎臟病患者的診斷效能，分析腎皮質(zhì)ADC值和髓質(zhì)FA值與血清肌酐水平(Scr)、腎小球濾過率估算值（eGFR）及慢性腎臟病分期之間的相關(guān)性。 結(jié)果：正常志愿者、慢性腎臟病患者雙腎皮髓質(zhì)ADC值和FA值之間均無統(tǒng)計學意義（P0.05）。各組腎皮質(zhì)的ADC值均高于髓質(zhì)ADC值，各組腎髓質(zhì)FA值均高于腎皮質(zhì)FA值。單因素方差分析顯示對照組、輕度慢性腎臟病和中重度慢性腎臟病之間腎皮髓質(zhì)ADC值和FA值均存在統(tǒng)計學差異。其中兩兩比較顯示腎皮質(zhì)ADC值和髓質(zhì)FA值在各兩組之間的差異明顯。腎臟髓質(zhì)擴散張量成像示蹤圖顯示腎臟髓質(zhì)的纖維束呈放射狀結(jié)構(gòu)自腎門指向腎皮質(zhì)。 結(jié)論：磁共振擴散張量成像技術(shù)（DTI）在腎臟具有可行性，可以從水分子擴散各向同性及各向異性等方面顯示腎臟生理學特征，并能反映慢性腎臟病的病理生理學改變。腎臟ADC值可以反映慢性腎臟病患者腎臟水分子擴散程度不同程度減低，腎臟髓質(zhì)FA值可以反映慢性腎臟病患者的腎臟髓質(zhì)內(nèi)水分子擴散的各向異性不同程度減低，對慢性腎臟病的診斷和不同分期的鑒別均有一定的診斷效能。
[Abstract]:Objective: to observe and measure the kidney of healthy volunteers and patients with CKD by using Mr diffusive Zhang Liang imaging technique, and to study the application of diffusive #internal_person1# imaging in CKD. To analyze the changes of ADC and FA in renal dermatomedullary in patients with CKD, and to analyze the correlation between DTI and renal function and CKD staging, and to explore the application value of DTI in chronic kidney disease. Participants and methods: 42 patients with chronic kidney disease treated in Department of Nephrology, first affiliated Hospital of Nanchang University, were collected and their serum creatinine levels were measured. The estimation of glomerular filtration rate (GFR) was calculated according to the simplified MDRD equation. CKD staging was determined according to eGFR, and 20 normal volunteers were collected as control group. Up to MRI dispersion Zhang Liang imaging was performed on 1.5T MRI equipment. The ADC value and FA value of renal dermatomedullary were measured, and the difference of ADC value and FA value of renal cortex and medulla were compared. The difference of ADC value and FA value of cortex and medulla between the control group and the patients with different stages of chronic kidney disease were compared and the ROC curve was drawn. To compare the diagnostic efficacy of renal cortex ADC and medullary FA between the control group and the patients with different stages of chronic kidney disease, and analyze the renal cortex ADC value, medullary FA value and serum creatinine level. The correlation between glomerular filtration rate (GFR) and stages of chronic kidney disease. Results: there was no significant difference between ADC value and FA value of renal medulla in normal volunteers and patients with chronic kidney disease. The ADC value of renal cortex in each group was higher than that of medullary ADC value. The FA value of renal medulla in each group was higher than that in renal cortex. Univariate analysis of variance showed that the control group. There were significant differences in ADC and FA between mild and moderate and severe chronic kidney disease, and the difference of ADC value and FA value in renal cortex was obvious between the two groups. The renal medullary diffusive Zhang Liang tracer graph showed that the fibrous bundles of the renal medulla were radially oriented from the renal hilum to the renal cortex. Conclusion: magnetic resonance diffusion imaging (DTI) is feasible in kidney, and it can show the physiological characteristics of kidney in the aspects of diffusion isotropy and anisotropy of water molecules. It can reflect the pathophysiological changes of chronic kidney disease. The ADC value of kidney can reflect the decrease of the degree of diffusion of water molecules in the kidney of patients with chronic kidney disease. The FA value of renal medulla can reflect the decrease of anisotropy of water molecule diffusion in renal medulla in patients with chronic kidney disease, and it has certain diagnostic efficacy for the diagnosis and differentiation of different stages of chronic kidney disease.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R692;R445.2

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