肾脏血流动力学特点在鉴别早期糖尿病肾病中的价值

Value of the renal hemadynamics index in differential diagnosis of type 2 diabetic nephropathy

目的:观察早期2型糖尿病肾病及原发性肾小球疾病不同肾内血流动力学特点,探讨其在二者中的鉴别诊断价值。方法:选取36例确诊2型糖尿病肾病(糖尿病肾病组,30mg/24h<尿蛋白<500mg/24h,早期)患者及原发性肾小球疾病患者30例(肾小球疾病组,轻度系膜增生性肾炎12例,IgA肾病17例,局灶节段性肾小球硬化1例)为研究对象;健康体检者27例为对照组。行肾动脉、肾内段间动脉、叶间动脉收缩期峰值流速、舒张期末血流速度、平均血流速度测定,计算相应动脉阻力指数(RI)及搏动指数(PI)。同时检测各组血、尿肌酐及尿白蛋白并计算Alb/Cr、eGRF。结果:与肾小球疾病组及对照组相比,糖尿病肾病组段间动脉RI、叶间动脉RI及段间动脉PI明显升高(P<0.01),但肾动脉RI及肾动脉PI、叶间动脉PI在3组之间无明显差异。相关分析显示糖尿病肾病组段间动脉、叶间动脉RI与患者糖化血红蛋白(r=0.64、0.62,P<0.01)及尿Alb/Cr比率(r=0.54、0.51,P<0.05)呈正相关关系。结论:2型糖尿病肾病早期存在血流动力改变,表现为肾小动脉抵抗,其在早期糖尿病肾病的鉴别诊断中有很好的应用价值。

Objectives To detect early alteration of renal blood flow in type 2 diabetic nephropathy （early stage） patients and evaluate value of the renal hemadynamics index in differential diagnosis of type 2 diabetic ncphropathy, Methods We randomly selected 36 patients with type 2 diabetes nephropathy as well as 30 glomerular disease patients, 27 age- and sex-matched controls. The resistivity indices （RIs） and pulsatility indices （PIs） of the main renal were calculated as well as albumin/creatinine ratio, glycated hemoglobin were tested. Result Compared with the glomerular disease patients and healtliy control subjects, diabetic patients had significantly higher RIs in the segmental and interlobar arteries （P = 0.001）, there was a significantly positive correlation between the RIs in the intrarenal arteries in diabetics and the alhumin/creatinine ratio （r = 0.54, 0.51）, glycated hemoglobin （r = 0.64, 0.62）. Conclusion The changes of renal hemadynarnics index exists in early type 2 diabetic patients with the appearance of intrarenal arteries resistance, which may be used as a new differential diagnosis characteristic feature.