【摘要】：背景DM是慢性流行代謝障礙性疾病,表現(xiàn)為患病率逐年增長趨勢(shì),已經(jīng)成為危害人類健康的主要疾病。胰腺脂肪沉積會(huì)大大增加T2DM的患病風(fēng)險(xiǎn)。近年來胰腺脂肪沉積和糖代謝異常的相關(guān)性研究日趨重視。超聲作為一種便利,經(jīng)濟(jì),快捷,可重復(fù)的檢查方式用于估測(cè)糖代謝異常人群的胰腺脂肪沉積情況,分析胰腺脂肪沉積與糖尿病多種高危因素的相關(guān)性,針對(duì)各種危險(xiǎn)因素早日采取防治措施,進(jìn)一步降低胰腺脂肪沉積率可有效降低DM的患病率、延緩糖尿病病程進(jìn)展。目的1.探討超聲估測(cè)胰腺脂肪沉積的可行性。2.分析胰腺脂肪沉積與多種糖尿病高危因素的相關(guān)性。方法選取年齡45~65歲(58±2)的糖尿病高發(fā)人群于2015年10月至2016年1月在上海市第六人民醫(yī)院東院行DM篩查,共計(jì)294人,除外嚴(yán)重心臟和腦血管疾病、肝臟和腎臟功能異常、各種感染、其他胰腺急慢性疾病或腫瘤、脾臟疾病、手術(shù)或其他應(yīng)激情況。采集人口學(xué)資料、現(xiàn)病史、既往史、人體學(xué)參數(shù),進(jìn)行生化指標(biāo)和胰腺普通超聲檢測(cè),以腹直肌為參照物估測(cè)胰腺脂肪沉積,依據(jù)回聲分為1、2、3級(jí)。其111例DM患者定為DM組,54例糖代謝障礙者定為IGR組,糖代謝無異常129人定為健康對(duì)照組。應(yīng)用社會(huì)科學(xué)統(tǒng)計(jì)軟件包(SPSS)16.0版本對(duì)數(shù)據(jù)統(tǒng)計(jì)分析。各組間觀察指標(biāo)差異的比較采用ANOVA方法;DM多個(gè)危險(xiǎn)因素與胰腺脂肪沉積的相關(guān)性分析采用Logistic回歸分析法。P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果1.健康組檢出胰腺脂肪沉積23例(17.8%),其中2級(jí)16,3級(jí)7;IGR組檢出16例(29.6%),其中2、3級(jí)分別為11、5例;DM組檢出34例(30.6%),其中2、3級(jí)分別為22、12例。3組間胰腺脂肪沉積患病率有統(tǒng)計(jì)學(xué)意義(P0.01)。胰腺脂肪沉積檢出率隨糖尿病病程的進(jìn)展逐漸增加(c2=19.14,P0.01)。2.TC(P=0.01)、TG(P=0.01)、LDL-C(P=0.00)、FPG(P=0.00)、HOMA2-IR(P=0.03)、HOMA-IS(P=0.00)在IGR組、DN組顯著高于對(duì)照組。3.BMI、HOMA2-IR、TG、TC可能是影響IGR、DM患者胰腺脂肪沉積的高危因素。結(jié)論1.BMI、HOMA2-IR、TG、TC可能是影響IGR、T2DM患者胰腺脂肪沉積的高危因素。2.超聲估測(cè)胰腺脂肪沉積具有可行性,為評(píng)價(jià)胰腺脂肪沉積提供一種方便、安全、無創(chuàng)的方法。背景糖尿病腎病(Diabetic Nephropathy,DN)是糖尿病常見的、嚴(yán)重的、預(yù)后較差的慢性并發(fā)癥,屬于糖尿病微血管病變,DN最終將發(fā)展到終末期腎病,因此近年來,DN的患病率居高不下,成為DM患者致死的主要原因之一[1]。目前,臨床通常用尿微量白蛋白這一指標(biāo)來診斷DN,當(dāng)糖尿病腎病確診時(shí),腎臟損害已發(fā)生了不可逆改變。在m Alb出現(xiàn)前,DM患者的腎臟組織已呈現(xiàn)病理和血流灌注的變化。因此,尋找一種無創(chuàng)、安全、有效的檢查方法來檢測(cè)DN腎臟組織的血流灌注改變有較高的臨床意義。目的1.采用超聲造影(contrast-enhanced ultrasound,CEUS)定量分析技術(shù)檢測(cè)早期DN腎臟組織血流灌注的改變。2.探討CEUS定量分析技術(shù)對(duì)早期糖尿病腎病腎臟組織血流灌注評(píng)估的使用價(jià)值。為早期評(píng)估糖尿病腎病患者腎臟組織血流灌注改變,提供一種新的影像學(xué)檢查方法。方法選取上海市第六人民醫(yī)院東院2015年10月-2016年1月糖尿病流行病調(diào)查糖代謝紊亂者34名,其中糖調(diào)節(jié)受損10例(IGR組),早期糖尿病腎病24例(DN組,m Alb20-200mg/mmol),健康對(duì)照組(NC組)10人。測(cè)定受檢者尿微量白蛋白(Urine trace albumin,m Alb)、尿微量白蛋白/尿肌酐(urine trace albumin/uric creatinine,m Alb/Cr)、血清肌酐(serum creatinine,Scr)、糖化血紅蛋白(glycosylated hemoglobin,Hb A1c)、血尿酸(blood uric acid,BUA)、血尿素氮(blood urea nitrogen,BUN);應(yīng)用MDRD公式:GFR(ml/min1.73m2)=186×(Scr)-1.154×(Age)-0.203×(0.742female),計(jì)算GFR,并做比較分析。使用PHILIPS i U Elit超聲診斷儀,對(duì)44例受檢者行超聲常規(guī)檢查雙側(cè)腎臟,隨后采用團(tuán)注法肘靜脈注射聲諾維(Sono Vue)超聲造影劑1.2m1,觀察動(dòng)態(tài)雙側(cè)腎臟超聲造影灌注成像。ROI定義為自由形狀,QLAB(Philips)軟件測(cè)定腎臟組織超聲造影灌注(DTPM)參數(shù),生成時(shí)間一強(qiáng)度曲線(time-intensity curve,TIC)灌注曲線,軟件自動(dòng)生出分析數(shù)值,包括曲線下面積(area under curve,AUC)、峰值強(qiáng)度(DPI)、曲線上升斜率(A)、達(dá)峰時(shí)間(TTP)。結(jié)果1.受檢者基本參數(shù)比較:IGR組、DN組m Alb(P=0.00)、m Alb/Cr(P=0.01)、Hb A1c(P=0.00)、UA(P=0.03)高于對(duì)照組。2.腎臟組織灌注實(shí)時(shí)觀察結(jié)果:經(jīng)肘靜脈采用團(tuán)注法注射聲諾維(Sono Vue)造影劑后,腎主動(dòng)脈、段動(dòng)脈、葉間動(dòng)脈、腎皮質(zhì)、腎髓質(zhì)、腎竇依以上順序強(qiáng)化。Sono Vue顯影的強(qiáng)度達(dá)到峰值后,漸漸消退直至消失。在NC受檢者,腎臟灌注Sono Vue后,示皮質(zhì)區(qū)的回聲強(qiáng)度高于髓質(zhì)區(qū);在IGR受檢者,皮質(zhì)區(qū)的回聲強(qiáng)度高于髓質(zhì)區(qū)。而在DN受檢者,腎臟灌注Sono Vue后,皮質(zhì)區(qū)回聲強(qiáng)度低于髓質(zhì)區(qū);造影劑洗脫,其廓清以腎竇、腎髓質(zhì)、腎皮質(zhì)依次為續(xù)。3.腎臟組織定量灌注參數(shù)分析結(jié)果:DN組腎皮質(zhì)、腎髓質(zhì)AUC、DPI大于NC組、IGR組(P0.05)。IGR組腎皮質(zhì)、腎髓質(zhì)AUC、DPI與NC組相比,差別未見有統(tǒng)計(jì)學(xué)差異。結(jié)論1.CEUS技術(shù)可發(fā)現(xiàn)早期糖尿病腎病腎臟血流灌注的異常,能有效分析評(píng)價(jià)早期DN血流灌注的變化。2.CEUS技術(shù)在糖調(diào)節(jié)受損期未見腎臟組織血流灌注顯著改變,CEUS技術(shù)在糖調(diào)節(jié)受損期未觀察到腎臟組織血流灌注顯著改變。
[Abstract]:BACKGROUND DM is a chronic epidemic metabolic disorder characterized by an increasing prevalence rate year by year and has become a major disease endangering human health. Pancreatic fat deposition greatly increases the risk of T2DM. In recent years, more and more attention has been paid to the correlation between pancreatic fat deposition and abnormal glucose metabolism. Repeated examinations were used to estimate pancreatic fat deposition in people with abnormal glucose metabolism, analyze the correlation between pancreatic fat deposition and various high-risk factors of diabetes mellitus, and take early preventive measures against various risk factors to further reduce pancreatic fat deposition rate, which can effectively reduce the prevalence of DM and delay the progress of diabetes. Methods A total of 294 people aged 45 to 65 years (58 2) with high risk of diabetes were screened for DM in the East Hospital of Shanghai Sixth People's Hospital from October 2015 to January 2016. Disease, abnormal liver and kidney function, various infections, other acute or chronic pancreatic diseases or tumors, splenic diseases, surgery or other stress conditions. Demographic data, current history, past history, anthropological parameters, biochemical parameters and pancreatic ultrasound were collected. Pancreatic fat deposition was estimated by using rectus abdominis as a reference. According to the echo, pancreatic fat deposition was divided into 1, 2, 3. 111 patients with DM were classified as DM group, 54 patients with impaired glucose metabolism were classified as IGR group and 129 healthy controls as control group. Results 1. 23 cases (17.8%) of pancreatic fat deposits were detected in healthy group, 16 cases (29.6%) in IGR group, 11 cases (11.6%) in grade 2 and 3, 34 cases (30.6%) in DM group, and 22 cases (12.3%) in grade 2 and 3 respectively (P 0.05). The detection rate of pancreatic fat deposition increased gradually with the progression of diabetes mellitus (c2 = 19.14, P 0.01). 2. TC (P = 0.01), TG (P = 0.01), LDL-C (P = 0.00), FPG (P = 0.00), HOMA2-IR (P = 0.03), HOMA-IS (P = 0.00) in IGR group, DN group was significantly higher than the control group. 3. BMI, HOMA2-IR, TG, TC may be the high risk factors of pancreatic fat deposition in DM patients. Background Diabetic nephropathy (DN) is a common, serious, and poor prognosis chronic complication of diabetes mellitus. In recent years, the prevalence of DN remains high, which is one of the main causes of death in DM patients [1].At present, microalbuminuria is commonly used as an indicator to diagnose DN. When diabetic nephropathy is diagnosed, renal damage has undergone irreversible changes. Before the appearance of Alb, the renal tissues of DM patients showed pathological and blood perfusion changes. Therefore, it is of great clinical significance to find a non-invasive, safe and effective method to detect the changes of renal blood perfusion in DN. Objective 1. To detect early DN kidney by contrast-enhanced ultrasound (CEUS) quantitative analysis technique. To explore the value of CEUS quantitative analysis technique in evaluating renal tissue perfusion in patients with early diabetic nephropathy. 34 patients with diabetes mellitus were investigated by epidemiological survey in January, 2001. Among them, 10 were impaired glucose regulation (IGR group), 24 were early diabetic nephropathy (DN group, m Alb 20-200mg/mmol), and 10 were healthy control group (NC group). Urine trace albumin (m Alb) and urine trace albumin/uric creatinine (m Alb) were measured. Alb/Cr, serum creatinine (Scr), glycosylated hemoglobin (Hb A1c), blood uric acid (BUA), blood urea nitrogen (BUN); MDRD formula: GFR (ml/min 1.73m2) = 186 * (Scr) - 1.154 * (Age) - 0.203 * (0.742 female), GFR was calculated and compared. Ultrasonography was performed in 44 patients with bilateral kidneys. Sono Vue was injected intravenously into the elbow with 1.2m1 contrast agent. Dynamic bilateral renal ultrasound perfusion imaging was observed. ROI was defined as free-form. The parameters of renal tissue contrast-enhanced ultrasound perfusion (DTPM) were measured by QLAB (Philips) software. The time of formation was one. Time-intensity curve (TIC) perfusion curve, software automatically generated analytical values, including area under curve (AUC), peak strength (DPI), curve rise slope (A), peak time (TTP). Results 1. Comparison of basic parameters: IGR group, DN group M Alb (P = 0.00), m Alb / Cr (P = 0.01), Hb A1c (P = 0.00), UA (P = 0.03) higher than the pair. Real-time observation of renal tissue perfusion: renal aorta, segmental artery, interlobar artery, renal cortex, renal medulla and renal sinus were enhanced in the above order after injection of Sono Vue into the elbow vein. The intensity of Sono Vue imaging reached the peak value and gradually disappeared until disappeared. The echo intensity in the cortex was higher than that in the medulla; in the IGR, the echo intensity in the cortex was higher than that in the medulla. There was no significant difference between IGR group and NC group in renal cortex, renal medulla AUC, DPI. Conclusion 1. CEUS technique can detect abnormal renal perfusion in early diabetic nephropathy, and can effectively analyze and evaluate the changes of early DN perfusion. 2. CEUS technique can not detect renal perfusion in impaired glucose regulation stage. There was no significant change in renal tissue perfusion during impaired glucose regulation by CEUS.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王順義;李怡;;超聲微泡介導(dǎo)靶向治療研究進(jìn)展[J];醫(yī)學(xué)與哲學(xué)(B);2017年01期

2 喬實(shí);賈化平;梁會(huì)澤;李華;張明明;宋文靜;;順鉑致兔急性腎損傷腎臟血流灌注的超聲造影研究[J];中國超聲醫(yī)學(xué)雜志;2016年11期

3 袁新春;肖帆;羅禮云;周愛云;蔣麗萍;;超聲造影診斷腎臟小腫瘤[J];中國醫(yī)學(xué)影像技術(shù);2016年05期

4 韓思維;丁炎;吳鵬西;周鋒盛;蔣驍;陳俊;朱巧英;;乳腺癌超聲及超聲造影與預(yù)后分子病理學(xué)標(biāo)志物相關(guān)性研究[J];生物醫(yī)學(xué)工程與臨床;2016年03期

5 張陽;米成嶸;王文;;靶向微泡超聲造影劑的研究進(jìn)展[J];寧夏醫(yī)科大學(xué)學(xué)報(bào);2016年04期

6 謝燕;;彩色多普勒與超聲造影對(duì)多房囊性腎癌及多房腎囊腫診斷價(jià)值研究[J];陜西醫(yī)學(xué)雜志;2016年03期

7 陳菲;盧岷;冉海濤;;超聲造影定量評(píng)價(jià)腎血流灌注研究進(jìn)展[J];中國介入影像與治療學(xué);2015年06期

8 李宏波;殷立平;張東生;;超聲靶向微泡破壞技術(shù)介導(dǎo)基因轉(zhuǎn)染的研究進(jìn)展[J];東南大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2015年01期

9 劉海芳;馮一星;勇強(qiáng);邢媛媛;張蕾;穆潔;;超聲造影定量評(píng)價(jià)腎動(dòng)脈狹窄支架置入術(shù)前術(shù)后實(shí)質(zhì)血流灌注的研究[J];中國超聲醫(yī)學(xué)雜志;2014年10期

10 趙麗;李明星;;超聲技術(shù)在糖尿病腎病診治中的應(yīng)用價(jià)值[J];中國醫(yī)學(xué)影像技術(shù);2014年02期

相關(guān)博士學(xué)位論文 前3條

1 張翊;超聲介導(dǎo)的微泡破壞促進(jìn)MSCs歸巢并修復(fù)糖尿病腎病的實(shí)驗(yàn)研究[D];第三軍醫(yī)大學(xué);2013年

2 關(guān)亞群;脂肪因子內(nèi)脂素和Chemerin在代謝綜合征發(fā)病機(jī)制中的作用研究[D];新疆醫(yī)科大學(xué);2011年

3 姜友昭;PPARδ對(duì)胰島β細(xì)胞脂代謝及胰島素分泌的影響[D];第三軍醫(yī)大學(xué);2007年

相關(guān)碩士學(xué)位論文 前3條

1 張丹丹;胰腺脂肪浸潤患者代謝綜合征及胰島素分泌狀況分析[D];山東大學(xué);2016年

2 王朝清;微血管損傷的靶向超聲造影劑制備及其黏附效能的實(shí)驗(yàn)研究[D];新鄉(xiāng)醫(yī)學(xué)院;2012年

3 孫孝杰;超聲造影對(duì)糖尿病兔腎臟血流灌注的實(shí)驗(yàn)研究[D];山西醫(yī)科大學(xué);2009年

，

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