MSCT灌注成像在糖尿病肾病诊断中的意义

目的探讨多层螺旋计算机断层扫描(MSCT)灌注成像在糖尿病肾病(DN)诊断中的应用价值。方法选取2016年9月~2018年9月间收治的64例2型糖尿病(T2DM)患者作为研究对象,根据尿白蛋白水平将患者分为正常白蛋白者(A组,n=21)、微量白蛋白者(B组,n=24)、大量白蛋白组(C组,n=19),所有患者均行MSCT灌注成像检查。比较三组患者肾脏灌注参数水平[肾皮质ROI血容量(BV)、血流量(BF)、毛细血管表面通透性(PS)、平均通过时间(MTT)],分析肾脏灌注参数与不同临床指标的相关性[空腹血糖(FBG)、尿素氮(BUN)、血肌酐(Cr)],以是否出现蛋白尿作为状态变量绘制MSCT肾脏灌注参数ROC曲线。结果①三组BV、BF、PS、MTT对比,差异有统计学意义(P<0.05);A组与B组BV、PS对比差异无统计学意义(P>0.05),A组较B组BF高、MTT低(P<0.05);A组和B组均较C组BV、BF、PS水平高(P<0.05),A组和B组均较C组MTT水平低(P<0.05);②Pearson相关性分析显示:BV、PS与FBG相关性不显著(P>0.05),与BUN、Cr呈负相关(P<0.05);BF与FBG、BUN、Cr呈负相关(P<0.05);MTT与FBG、BUN、Cr呈正相关(P<0.05);③ROC曲线显示,MTT预测肾损伤效能最高,其次是BV和PS(P<0.05)。结论MSCT灌注成像参数能反映DN患者肾损害,有利于为DN诊治提供更多有效信息。

Significance of MSCT Perfusion Imaging in the Diagnosis of Diabetic Nephropathy

Objective To explore the application value of multi-slice spiral computed tomography(MSCT) perfusion imaging in the diagnosis of diabetic nephropathy(DN). Methods 64 patients with type 2 diabetes mellitus(T2DM) who were admitted between September 2016 and September 2018 were selected for the study and were divided into normal albumin group(group A, n=21), microalbumin group(group B, n=24) and massive albumin group(group C, n=19) according to the urinary albumin level. All patients were given MSCT perfusion imaging. The levels of renal perfusion [blood volume(BV) of renal cortex ROI, blood flow(BF), capillary permeability surface(PS), mean transit time(MTT)] were compared among the three groups. The correlation between renal perfusion parameters and different clinical indicators [fasting blood glucose(FBG), urea nitrogen(BUN), serum creatinine(Cr)] was analyzed. The ROC curves of MSCT renal perfusion parameters were plotted by taking presence or absence of proteinuria as a state variable. Results ①There were statistically significant differences in the BV, BF, PS and MTT among the three groups(P<0.05). There were no significant differences in the BV and PS between group A and group B(P>0.05), and the BF was higher and MTT was lower in group A compared with group B(P<0.05). The levels of BV, BF and PS in group A and group B were higher than those in group C(P<0.05) while the level of MTT in group A and group B was lower than that in group C(P<0.05). ②Pearson correlation analysis showed that the BV and PS were not significantly correlated with FBG(P>0.05), and were negatively correlated with BUN and Cr(P<0.05). BF was negatively correlated with FBG, BUN and Cr(P<0.05). ③MTT was positively correlated with FBG, BUN and Cr(P<0.05). ROC curve showed that MTT had the highest efficacy in predicting renal injury, followed by BV and PS(P<0.05). Conclusion MSCT perfusion imaging parameters can reflect the efficacy of renal injury in patients with DN, and they are helpful to provide more effective information for the diagnosis and treatment of DN.