本文選題：腎臟　切入點(diǎn)：磁共振成像　出處：《天津醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：本研究運(yùn)用血氧水平依賴磁共振成像(BOLD MRI)探討2型糖尿病及其腎病患者腎臟的BOLD成像特點(diǎn),評估其腎臟皮髓質(zhì)的氧合狀態(tài),并分析腎臟皮髓質(zhì)R2*值與血清胱抑素C (Cys C)、腎小球?yàn)V過率估算值(eGFR)之間的相關(guān)性,以期探尋一種無創(chuàng)、敏感的評價(jià)腎功能的方法。方法：選取天津市第四中心醫(yī)院2014年3月至2015年3月于內(nèi)分泌科住院部收治的2型糖尿病(T2DM)患者共21例,均符合1999年美國糖尿病協(xié)會(ADA)提出的2型糖尿病診斷標(biāo)準(zhǔn),其中糖尿病腎病(DKD)患者8例,單純2型糖尿病患者13例。納入的單純2型糖尿病患者均無糖尿病各種急慢性并發(fā)癥和各種原因所致的急、慢性腎病。所有患者需測量血清Cys C、血清肌酐(Scr),并根據(jù)簡化腎臟病膳食改良試驗(yàn)方程(MDRD)估算腎小球?yàn)V過率(GFR)。另外選取與受試患者年齡、性別相匹配的健康志愿者20例。經(jīng)醫(yī)院倫理委員會批準(zhǔn),所有受試者均簽署了知情同意書。采用3.0T磁共振掃描儀(Achieva TX, Philips Healthcare)對所有受試者進(jìn)行腎臟常規(guī)MRI及冠狀位BOLD掃描。分別測量各組腎皮質(zhì)、髓質(zhì)的R2*值,采用配對樣本t檢驗(yàn)比較各組腎臟皮質(zhì)與髓質(zhì)之間R2*值的差異,采用單因素方差分析比較各組之間腎臟皮質(zhì)間、髓質(zhì)間R2*值的差異。2型糖尿病及其腎病組腎臟皮、髓質(zhì)R2*值與血清Cys C、eGFR之間的相關(guān)性采用Pearson相關(guān)性分析方法。結(jié)果：所有受試者全部納入圖像分析。健康對照組、單純T2DM組與DKD組腎臟髓質(zhì)R2*值均顯著高于皮質(zhì)(P0.001)。經(jīng)單因素方差分析顯示,健康對照組、單純T2DM組與DKD組之間腎臟皮質(zhì)、髓質(zhì)R2*值均存在統(tǒng)計(jì)學(xué)差異(P0.05)。Tukey檢驗(yàn)進(jìn)行兩兩比較顯示,DKD組較單純T2DM組及正常對照組皮質(zhì)R2*值均明顯增加(P0.05),而單純T2DM組與健康對照組皮質(zhì)R2*值之間無統(tǒng)計(jì)學(xué)差異(P0.05)；單純T2DM組與DKD組髓質(zhì)R2*值較健康對照組均明顯增加,而DKD組髓質(zhì)R2*值低于單純T2DM組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。Pearson相關(guān)性分析顯示,單純T2DM組髓質(zhì)R2*值與血清Cys C、eGFR均呈正相關(guān)(P0.05)；單純T2DM組皮質(zhì)R2*值與eGFR、血清Cys C均無明顯相關(guān)性(P0.05)；DKD組皮、髓質(zhì)R2*值均與血清Cys C呈正相關(guān)(P0.05),與eGFR呈負(fù)相關(guān)(P0.05),其中以皮質(zhì)R2*值與血清Cys C之間的相關(guān)強(qiáng)度最高。結(jié)論：BOLD MRI能夠無創(chuàng)、敏感、可靠地評估正常人與2型糖尿病及其腎病患者腎臟皮髓質(zhì)氧合水平。正常人腎臟髓質(zhì)處于生理性缺氧狀態(tài),2型糖尿病患者腎髓質(zhì)顯著缺氧,而糖尿病腎病患者皮髓質(zhì)均顯著缺氧,皮髓質(zhì)R2*值的改變可以反映腎功能的變化。
[Abstract]:Objective: to investigate the characteristics of renal BOLD imaging in patients with type 2 diabetes mellitus and its nephropathy by using blood oxygen level dependent magnetic resonance imaging (bod MRI), and to evaluate the oxygenation status of renal medulla. The correlation between R2 * value of renal skin medulla and serum cystatin C cystein-Cys Con, glomerular filtration rate (GFR) was analyzed in order to explore a non-invasive method. Methods: a total of 21 patients with type 2 diabetes mellitus (T2DM) admitted from March 2014 to March 2015 in Department of Endocrinology in Tianjin 4th Central Hospital were selected. All of them were in accordance with the diagnostic criteria for type 2 diabetes proposed by the American Diabetes Association (ADA) in 1999, including 8 patients with diabetic nephropathy (DKD). There were 13 patients with type 2 diabetes mellitus. All the patients with type 2 diabetes did not have all kinds of acute and chronic complications of diabetes and the urgency caused by various causes. Chronic nephropathy. All patients should measure serum Cys C, serum creatinine creatinine, and estimate glomerular filtration rate (GFR) according to simplified dietary improvement test equation. 20 sex-matched healthy volunteers, approved by the Hospital Ethics Committee, All the subjects signed the informed consent form. All subjects were examined with conventional MRI and coronal BOLD scanning using 3.0T MRI scanner Achieva TX, Philips Healthcare. The R2 * values of renal cortex and medulla were measured in each group. The difference of R2 * value between renal cortex and medulla in each group was compared by paired sample t test, and the difference of R2 * value between renal cortex and medulla between each group was compared by univariate analysis of variance (ANOVA). 2 the renal skin of type 2 diabetes mellitus and its nephropathy group were compared by single factor analysis of variance (ANOVA). The correlation between medullary R2 * value and serum Cys CfGFR was analyzed by Pearson method. Results: all subjects were included in the image analysis. The R2 * value of renal medulla in simple T2DM group and DKD group was significantly higher than that in cortical cortex P0.001.The univariate analysis of variance showed that the renal cortex of healthy control group, simple T2DM group and DKD group was significantly higher than that of DKD group. There was significant difference in R2 * value of medulla between two groups (P0.05U. Tukey test). The results showed that the R2 * value of cortex in DKD group was significantly higher than that in T2DM group and normal control group, but there was no significant difference in R2 * value between T2DM group and healthy control group (P0.05). The medullary R2 * value in T2DM group and DKD group was significantly higher than that in healthy control group. The medullary R2 * value in DKD group was significantly lower than that in T2DM group. Pearson correlation analysis showed that the medullary R2 * value in T2DM group was positively correlated with serum Cys Cngfr value (P0.05), the cortical R2 * value in T2DM group had no significant correlation with eGFRand the serum Cys C level had no significant correlation with the skin of T2DM group, and there was no significant correlation between R2 * value and EGF R2 * value in T2DM group, and there was no significant correlation between R2 * value and serum Cys C in T2DM group. The medullary R2 * values were positively correlated with serum Cys C and negatively correlated with eGFR. The cortical R2 * value and serum Cys C had the highest correlation intensity. The renal medullary oxygenation levels in normal subjects and patients with type 2 diabetes mellitus and their nephropathy were evaluated reliably. The renal medulla in normal subjects was in a physiologic anoxic state and the renal medulla was significantly hypoxic in patients with type 2 diabetes mellitus. The medulla of diabetic nephropathy patients were significantly hypoxic, and the change of R2 * value of skin medulla could reflect the change of renal function.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R587.2;R445.2

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相關(guān)期刊論文 前1條

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本文編號：1580279