剪切波弹性成像定量评估糖尿病肾病患者肾损害程度

目的探讨剪切波弹性成像（SWE）技术评价糖尿病肾病（DN）患者肾损害程度的临床应用价值。 方法选取2018年1月至2020年1月在青岛大学附属医院就诊的DN患者155例，根据尿蛋白/肌酐（ACR）水平不同将其分为正常白蛋白尿组55例（ACR＜30 mg/g）、微量白蛋白尿组50例（30 mg/g≤ACR≤300 mg/g）、临床白蛋白尿组50例（ACR＞300 mg/g）。另选取健康体检者46例为对照组。应用SWE检测4组的肾实质弹性模量最大值（Emax）、平均值（Emean）、最小值（Emin），并测定各组血清胱抑素C（CysC），比较各组间弹性模量值及CysC的变化，并对DN各组的弹性模量值与CysC之间的相关性进行分析。 结果DN各组的Emax、Emean、Emin测值均大于健康对照组，且随着ACR水平增高，Emax、Emean、Emin呈逐渐增大趋势，即临床白蛋白尿组＞微量白蛋白尿组＞正常白蛋白尿组＞对照组，组间差异均有统计学意义（P均＜0.05）。正常白蛋白尿组与对照组的CysC水平比较，差异无统计学意义（P=0.124），DN各组CysC水平比较，临床白蛋白尿组＞微量白蛋白尿组＞正常白蛋白尿组，组间差异均有统计学意义（P均＜0.05）。DN患者肾实质弹性模量值Emax、Emean、Emin与CysC均呈正相关（r=0.808、0.829、0.807，P均＜0.05）。 结论SWE可无创定量评价DN患者肾损害程度，为动态监测疾病进展、评估临床干预效果及调整治疗方案提供依据。

Value of shear wave elastography in quantitative evaluation of patients with type 2 diabetic nephropathy

ObjectiveTo evaluate the clinical value of shear wave elastography (SWE) in evaluating the degree of renal damage in patients with type 2 diabetic nephropathy. MethodsA total of 155 diabetic nephropathy patients treated at the Affiliated Hospital of Qingdao University from January 2018 to January 2020 were collected and divided into a normalbuminuria group (55 patients, ACR ＜ 30 mg/g), microalbuminuria group (50 patients, 30 mg/g≤ACR≤300 mg/g), and clinical proteinuria group (50 patients, ACR ＞ 300 mg/g) according to their urinary albumin/creatinine ratio (ACR). Forty-six healthy subjects were selected as a control group. SWE was used to detect the renal parenchymal Young's modulus Emax, Emean, and Emin of the four groups, and serum cystatin C (CysC) of each group was also determined. The changes of Young's modulus and CysC were compared among the four groups, and the correlation between Young's modulus and CysC of each group was analyzed. ResultsEmax, Emean, and Emin were highest in the clinical proteinuria group, followed by the microalbuminuria group, normalbuminuria group, and control group; the differences between groups were statistically significant (P＜0.05). There was no statistically significant difference in CysC levels between the normalbuminuria group and the control group (P=0.124), but there were statistically significant differences between the other two groups and the control group as well as between any two of the normalbuminuria group, microalbuminuria group, and clinical proteinuria group (P＜0.05). There was a positive correlation between Emax, Emean, and Emin and CysC in patients with type 2 diabetic nephropathy (r=0.808, 0.829, and 0.807, respectively, P＜0.05). ConclusionSWE can quantitatively evaluate the degree of renal damage in type 2 diabetic nephropathy, and provide a basis for dynamic monitoring of disease progression, evaluation of clinical intervention effect, and adjustment of treatment plan.