声触诊组织定量技术对糖尿病肾病患者肾损害的评估价值

目的探讨声触诊组织定量（VTQ）技术诊断糖尿病肾病（DN）的价值。 方法收集2017年3月至2019年3月在西南医科大学附属医院内分泌科临床确诊的糖尿病患者79例，根据尿蛋白排泄率（UAER）分为极微量蛋白尿组（31例）、微量蛋白尿组（27例）及大量蛋白尿组（21例），选择30例健康体检者作为健康对照组。应用VTQ技术测量各组研究对象的肾皮质剪切波传播速度（SWV），采用单因素方差分析比较不同组间SWV的差异，组间两两比较采用LSD-t检验，采用Pearson相关分析分析SWV值变化及与UAER之间的相关性，构建SWV的受试者操作特征（ROC）曲线。 结果随着DN患者肾实质损害程度的加重，SWV值逐渐降低，健康对照组、极微量蛋白尿组、微量蛋白尿组及大量蛋白尿组肾组织SWV值分别为：（3.31±0.45）m/s、（3.12±0.35）m/s、（2.56±0.08）m/s和（1.96±0.07）m/s，其中微量蛋白尿组和大量蛋白尿组SWV值较健康对照组和极微量蛋白尿组明显降低，差异具有统计学意义（t=8.973、16.155、8.653、17.931，P均<0.001）。患者肾皮质SWV与UAER存在负相关（r=-0.802，P<0.001）。SWV诊断早期DN的ROC曲线下面积为0.783，当截断值为3.31 m/s时，敏感度和特异度分别为86.2%和70.0%。 结论VTQ技术可无创定量评价DN患者肾实质弹性变化，SWV值与UAER具有较好的负相关关系，是评价DN患者早期肾损害的有效指标。

Value of virtual touch tissue quantification technique in evaluating renal damage in patients with diabetic nephropathy

ObjectiveTo evaluate the value of virtual touch tissues quantification (VTQ) in the diagnosis of diabetic nephropathy (DN). MethodsSeventy-nine patients who were clinically diagnosed with diabetes at the Department of Endocrinology, Affiliated Hospital of Southwest Medical University from March 2017 to March 2019 were collected. According to the urinary albumin excretion rate (UAER), they were divided into a minimal microalbuminuria group (n=31), microalbuminuria group, (n=27) and massive albuminuria group (n=21). Thirty healthy people were selected as a healthy control group. The renal cortex shear wave velocity (SWV) of each group was measured by VTQ technique. The difference of SWV among different groups was compared by one-way ANOVA, and LSD-t test for pairwise comparison between groups. Pearson correlation analysis was used to analyze the correlation of change of SWV value with UAER. The receiver operating characteristic (ROC) curve of SWV was plotted to determine its performance in the diagnosis of early DN. ResultsWith the aggravation of renal parenchyma damage in DN patients, the SWV value decreased gradually; the SWV values of the healthy control group, minimal microalbuminuria group, microalbuminuria group, and massive albuminuria group were (3.31±0.45) m/s, (3.12±0.35)m/s, (2.56±0.08) m/s, and (1.96±0.07) m/s, respectively. The SWV values of the microalbuminuria group and massive albuminuria group were significantly lower than those of the healthy control group and minimal microalbuminuria group (t=8.973, 16.155, 8.653, 17.931, P<0.001). There was a negative correlation between renal cortex SWV and UAER (r= -0.802, P<0.01). The area under the curve of SWV for diagnosis of early DN was 0.783. When the cut-off value was 3.31 m/s, the sensitivity and specificity were 86.2% and 70%, respectively. ConclusionVTQ technique can noninvasively quantitatively evaluate the renal parenchyma elasticity changes of DN patients. SWV has a good negative correlation with UAER, which is an effective index to evaluate early renal damage in DN patients.