慢性肾脏病的皮髓质ADC值与肾脏功能及病理的相关性研究

目的探讨慢性肾脏病(chronic kidney disease,CKD)患者的皮髓质表观扩散系数(apparent diffusion coef-ficient,ADC)变化规律及其与肾脏功能及病理改变的相关性。资料与方法对临床诊断并接受肾脏穿刺活检的21例CKD患者(CKD组)和27名健康志愿者(对照组)均行常规MRI和扩散加权成像(DWI),b值取0、500 s/mm2和0、1000 s/mm2两组,测量健康志愿者与CKD患者的肾脏皮髓质ADC值,并分析皮髓质ADC值与肾脏功能指标及小管间质损伤程度之间的相关性。结果 CKD患者的肾脏皮髓质ADC500、ADC1000值均显著低于正常对照组(P<0.001)。CKD患者的皮髓质ADC1000值与肾小球滤过率估算值(eGFR)均呈正相关(P<0.01),皮质ADC500、ADC1000值与CKD分期呈负相关(P<0.05)。CKD患者的皮髓质ADC500、ADC1000值与小管间质损伤评分均呈负相关(P<0.05),以皮质ADC1000值为著(P<0.01)。结论肾脏皮髓质ADC值能在一定程度上反映CKD患者的肾脏功能及小管间质损伤程度,以皮质ADC1000值最敏感。

Correlation Between Cortical and Medullary ADC Values with Renal Function and Pathological Characteristic in Chronic Kidney Disease

Objective To investigate the features of renal cortical and medullary ADC values of chronic kidney disease(CKD) patients,and to explore the correlation between cortical and medullary ADC values with renal function and pathological characteristic.Materials and Methods 21 patients with CKD and 27 healthy volunteers were included.All of them received conventional magnetic resonance imaging(MRI) and DWI examinations with two group of b values,0、500 and 0、1000(s/mm2).The cortical and medullary ADC values of control group and CKD group were measured.Correlation between cortical and medullary ADC values with renal function and tubulointerstitial injury degree were analyzed in CKD patients.Results The cortical and medullary ADC500、ADC1000 values of CKD group were significantly lower than the controlgroup(P<0.001).Positive correlations were found between the cortical and medullary ADC1000 values with estimated glomerular filtration rate(P<0.01).Cortical ADC500 and ADC1000 values correlated negatively with CKD grade(P<0.05).Cortical and medullary ADC500、ADC1000 values correlated negatively with tubulointerstitial injury degree(P<0.05).Conclusion Renal cortical and medullary ADC values can reflect the kidney function and tubulointerstitial injury degree in chronic kidney disease,and cortical ADC1000 value is the most sensitive parameter.