本文選題：慢性腎臟病 + 血氧水平依賴核磁共振成像（BOLD　； 參考：《蘇州大學(xué)》2014年碩士論文

【摘要】：目的 本研究旨在通過對(duì)核磁共振BOLD成像及DWI的研究，探討雙腎皮、髓質(zhì)ADC值及R2*值與慢性腎臟病患者腎臟結(jié)構(gòu)和功能變化的關(guān)系，探討核磁共振BOLD成像及DWI作為一種無(wú)創(chuàng)性、無(wú)毒性的檢查方法在慢性腎臟病早期發(fā)現(xiàn)、預(yù)后判斷及病程檢測(cè)中的臨床價(jià)值。 材料與方法 2012年12月-2013年12月對(duì)68例實(shí)驗(yàn)對(duì)象進(jìn)行核磁共振BOLD及DWI成像。其中健康對(duì)照組19例。CKD組：選取慢性腎臟病患者共49例，其中行腎臟穿刺活檢者26人，按照CKD分期將患者分為兩個(gè)亞組。記錄掃描對(duì)象的性別，年齡，體重，血肌酐及尿素氮，通過CG公式計(jì)算出其eGFR，并檢測(cè)患者晨尿白蛋白、尿肌酐及胱抑素C的含量，腎活檢患者使用單項(xiàng)病理?yè)p害積分半定量方法：對(duì)9項(xiàng)病理指標(biāo)進(jìn)行病理積分，均為0-3分。 所有實(shí)驗(yàn)對(duì)象掃描均使用采用3.0T MRI掃描儀。定位像：橫斷，冠狀位及矢狀位；常規(guī)MRI序列：T2WI橫斷位及冠狀位，T1WI橫斷位，快速旋轉(zhuǎn)回波序列；BOLD成像序列：冠狀位，序列為多次梯度回波序列，DW：b值為800s/mm2。掃描過程中使用SENSE Cardiac線圈及呼吸門控技術(shù)。BOLD序列掃描患者需閉氣16s。 全部數(shù)據(jù)使用SPSS17.0軟件包進(jìn)行統(tǒng)計(jì)學(xué)分析，所有計(jì)量資料均進(jìn)行正態(tài)分布和方差齊性檢驗(yàn),結(jié)果用均數(shù)±標(biāo)準(zhǔn)差表示。分別比較各組間腎臟皮、髓質(zhì)ADC值與R2*值的差異及與腎功能及病理相關(guān)指標(biāo)的關(guān)系。分別使用方差分析、t檢驗(yàn)、Pearson相關(guān)分析及Spearman相關(guān)分析,P0．05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果 1.對(duì)照組及CKD組皮質(zhì)ADC值均明顯高于髓質(zhì)（P0.05）；兩組皮質(zhì)R2*值均明顯小于髓質(zhì)（P0.05）。CKD組左右兩側(cè)腎臟皮、髓質(zhì)ADC值無(wú)明顯差異（P0.05）；CKD組患者左右兩側(cè)腎臟皮、髓質(zhì)ADC值及R2*比較無(wú)明顯差異（P0.05）。 2. CKD組與對(duì)照組腎臟皮質(zhì)ADC值及R2*值比較，ADC值明顯降低，R2*值明顯升高，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；CKD組與正常組腎臟髓質(zhì)ADC值及R2*值比較明顯降低，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。 3.對(duì)照組腎臟皮髓質(zhì)的ADC值及R2*值與早期腎功能損害組及中晚期腎功能損害組比較，兩亞組皮、髓質(zhì)ADC值及髓質(zhì)R2*值明顯降低，皮質(zhì)R2*明顯升高，差異均有統(tǒng)計(jì)學(xué)意義（P0.05）；中晚期腎功能損害組與早期腎功能損害組相比較，皮質(zhì)ADC值及髓質(zhì)R2*值明顯降低，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；兩亞組髓質(zhì)ADC值及皮質(zhì)R2*值之間差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。 4.腎臟皮質(zhì)ADC值與血肌酐、尿素氮呈負(fù)相關(guān)，與eGFR呈正相關(guān)（r分別為-0.14、-0.27、0.35，P均0.05）；皮質(zhì)R2*值與尿白蛋白/肌酐呈負(fù)相關(guān)（r=-0.4，P0.05）；髓質(zhì)R2*值與血肌酐、尿素氮、尿胱抑素C呈負(fù)相關(guān)，與eGFR呈正相關(guān)（r分別為-0.39、-0.48、0.21、-0.34，P均0.05）。 5.腎活檢患者皮質(zhì)ADC值與系膜細(xì)胞增殖、球囊連/小新月體、腎小管萎縮、間質(zhì)炎細(xì)胞浸潤(rùn)、間質(zhì)纖維化、小動(dòng)脈病變呈負(fù)相關(guān)，有統(tǒng)計(jì)學(xué)意義（r值分別為-0.44、-0.55、-0.41、-0.55、-0.55、-0.4，P均0.05）；皮質(zhì)R2*值與系膜細(xì)胞增殖呈正相關(guān)（r=0.47，P0.05）。 結(jié)論 1.腎臟核磁共振BOLD成像及DWI能夠顯示腎臟皮質(zhì)及髓質(zhì)之間的結(jié)構(gòu)及功能差異，，從而能夠反映腎臟皮、髓質(zhì)的生理功能。 2.測(cè)量腎臟ADC值及R2*值可以作為慢性腎臟病早期診斷的依據(jù)； 3.腎臟皮質(zhì)ADC值可以作為一種無(wú)創(chuàng)性評(píng)估腎臟功能，監(jiān)測(cè)慢性腎臟病患者病情進(jìn)展，判斷治療效果的重要方法之一； 4.腎臟髓質(zhì)R2*值與皮質(zhì)R2*值結(jié)合，能夠較為全面的判斷腎小球及腎臟小管間質(zhì)病變，無(wú)創(chuàng)監(jiān)測(cè)腎功能進(jìn)展； 5.腎臟核磁共振BOLD成像及DWI相結(jié)合能夠更加全面的評(píng)價(jià)腎臟功能及病理改變，在未來(lái)慢性腎臟病診療中有非常重要的作用。
[Abstract]:objective
The purpose of this study is to explore the relationship between the renal structure and function of the renal cortex, the ADC value of medulla and the value of R2* and the changes of renal function in patients with chronic renal disease by the study of nuclear magnetic resonance BOLD imaging and DWI. The purpose of this study is to explore the early detection of NMR BOLD imaging and DWI as a noninvasive and non-toxic method in the early detection of chronic kidney disease, prognosis judgment and course detection. The clinical value of it.
Materials and methods
NMR BOLD and DWI imaging were performed in 68 subjects in December -2013 December 2012. In the healthy control group, 19 patients with chronic kidney disease were selected, including 49 patients with chronic kidney disease, including 26 kidney biopsy subjects. The patients were divided into two subgroups according to CKD stage. The eGFR was calculated by CG formula and the content of early morning urine albumin, urine creatinine and cystatin C were measured. The renal biopsy patients used a semi quantitative method of single pathological damage score: the pathological scores of 9 pathological indexes were 0-3 points.
All the subjects were scanned using 3.0T MRI scanner. Location image: transection, coronal and sagittal position; conventional MRI sequence: T2WI transverse and coronal, T1WI transversal, fast rotating echo sequence; BOLD imaging sequence: coronal position, sequence as multiple gradient echo sequence, DW:b value for 800s/mm2. scanning process using SENSE Car. DIAC coil and respiratory gating technology.BOLD sequence scanning patients need 16s.
All data were statistically analyzed using SPSS17.0 software package. All the data were tested in normal distribution and homogeneity of variance. The results were expressed with mean standard deviation. The differences in renal cortex, medulla ADC value and R2* value were compared and the relationship with renal function and pathological indexes were compared. Variance analysis, t test, and Pearson were used respectively. Correlation analysis and Spearman correlation analysis showed that P0.05 was statistically significant.
Result
The cortical ADC values of 1. control groups and CKD groups were significantly higher than that of medulla (P0.05), and the R2* values in two groups were significantly smaller than those of the medulla (P0.05).CKD group, and the medulla ADC values were not significantly different (P0.05), and there was no significant difference between the left and right renal cortex of the left and right sides of the CKD group, the ADC value of medulla and R2* (P0.05).
2. CKD group and the control group compared with the renal cortex ADC value and R2* value, ADC value decreased significantly, R2* value increased significantly, the difference was statistically significant (P0.05), CKD group and normal group renal medullary ADC value and R2* value was significantly lower, the difference was statistically significant (P0.05).
The ADC value and R2* value of renal cortex medulla in 3. control groups were compared with the early renal function damage group and the middle and late renal impairment group. The two subgroups, the ADC value and the medulla R2* value of the medulla, and the cortical R2* were significantly increased, the difference was statistically significant (P0.05); the middle and late renal function damage group was compared with the early renal function damage group, and the cortical ADC value was compared with the early renal function damage group. The R2* value of medulla decreased significantly (P0.05); there was no significant difference in ADC value and cortical R2* value between the two subgroups (P0.05).
4. the ADC value of renal cortex was negatively correlated with serum creatinine, urea nitrogen and positive correlation with eGFR (r was -0.14, -0.27,0.35, P 0.05, respectively), and the cortical R2* value was negatively correlated with urinary albumin / creatinine (r=-0.4, P0.05), and the R2* value of medulla was negatively correlated with serum creatinine, urea nitrogen and urinary cystatin C, and was positively correlated with eGFR (0.05 ).
5. the ADC values of renal biopsy and mesangial cell proliferation, balloon connection / small new month body, renal tubule atrophy, interstitial inflammatory cell infiltration, interstitial fibrosis and negative correlation of arteriopathy were negative (r value was -0.44, -0.55, -0.41, -0.55, -0.55, -0.4, P 0.05), and the cortical R2* value was positively correlated with the proliferation of mesangial cells (r=0.47, P0.05).
conclusion
1. renal magnetic resonance imaging (BOLD) and DWI can show differences in structure and function between renal cortex and medulla, which can reflect the physiological functions of renal cortex and medulla.
2. measuring renal ADC and R2* values can be used as the basis for early diagnosis of chronic kidney disease.
3. the ADC value of renal cortex can be used as a non-invasive method for assessing renal function, monitoring the progression of chronic kidney disease and determining the therapeutic effect.
4. the R2* value of renal medulla combined with the R2* value of cortex can be used to judge glomeruli and tubulointerstitial lesions in a more comprehensive way.
5. the combination of renal nuclear magnetic resonance BOLD imaging and DWI can make a more comprehensive evaluation of renal function and pathological changes. It has a very important role in the diagnosis and treatment of chronic kidney disease in the future.

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R692;R445.2

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