DTI量化评估慢性肾脏病患者肾功能状态及损伤程度的价值

目的探讨扩散张量成像(diffusion tensor imaging,DTI)量化对慢性肾脏病(chronic kidney disease,CKD)患者肾功能状态及肾功能损伤程度的临床预测价值。方法选取本院诊治的轻度(1~2期)CKD患者43例为轻度组,中重度(3~5期)CKD患者45例为中重度组,同期体检健康者50例为健康对照组。比较三组DTI相关参数各向异性分数(fractional anisotropy,FA)及表观弥散系数(apparentdiffusion coefficient,ADC)水平与肾功能指标的相关性;评估DTI量化指标对CKD肾功能及肾损伤的预测价值。结果三组皮质和髓质ADC值与FA值水平比较差异有统计学意义(P<0.05)且皮质和髓质ADC、FA值对照组>轻度组>重度组。三组肾功能指标比较差异有统计学意义(P<0.05),Scr、24h-Upro水平对照组<轻度组<重度组,eGFR水平对照组>轻度组>重度组。相关分析显示,皮质和髓质的ADC和FA值与均Scr、24h-Upro呈负相关,与eGFR呈正相关(P<0.05)。ROC曲线显示,髓质FA预测中重度CKD具有一定准确性(AUC=0.852,敏感度、特异度为82.2%、79.8%)。结论DTI量化相关参数对CKD,患者肾功能状态及损伤程度具有重要的预测价值。

The value of DTI in evaluating renal function status and injury degree in patients with chronic kidney disease

Objective To explore the value of diffusion tensor imaging(DTI)in quantifying the clinical predictive value of renal function status and renal impairment in patients with chronic kidney disease(CKD).Methods 43 cases of mild(stage 1~2)CKD patients treated in our hospital from October 2018 to June 2019 were selected as mild group,45 cases of moderate to severe(stage 3~5)CKD patients were selected as moderate to severe group,and 50 cases of healthy people were selected as healthy control group.We compared three groups of DTI related parameters of anisotropic score(fractional anisotropy,FA)and apparent diffusion coefficient(apparentdiffusion coefficient,ADC)levels and renal index of correlation and evaluated the predictive value of DTI for renal function and renal injury in CKD.Results There were statistically significant differences between the three groups in the levels of cortical and medullary ADC and FA(P<0.05),and the cortical and medullary ADC and FA control groups in the>mild>severe group.There were statistically significant differences in renal function between the three groups(P<0.05)i.e.,Scr and 24h-upro level control groupmild group>severe group.Correlation analysis showed that ADC and FA values of cortex and medulla were negatively correlated with mean Scr and 24h-upro,and positively correlated with eGFR(P<0.05).ROC curve showed that medullary FA predicted moderate and severe CKD with certain accuracy(AUC=0.852,sensitivity and specificity were 82.2%and 79.8%).Conclusion DTI quantified correlation parameters have important predictive value for renal function status and injury degree in CKD patients,which is worthy to be widely promoted in clinical practice.