超声评价糖尿病肾病肾内动脉阻力指数异常及与颈动脉粥样硬化相关性研究

Evaluation of the abnormality of intra-renal arterial resistance index and its correlation with carotid artery atherosclerosis in type 2 diabetes nephropathy with ultrasonography

目的运用彩色多普勒超声评价糖尿病肾病(DN)肾内动脉阻力指数(RI)异常及其与颈动脉粥样硬化的相关性。方法 62例2型糖尿病肾病患者根据肾小球滤过率(GFR)分为三组:GFR≥90 ml·min-1·(1.73 m2)-1为A组,60 ml·min-1·(1.73 m2)-1≤GFR<90 ml·min-1·(1.73 m2)-1为B组(25例),GFR<60 ml·min-1·(1.73 m2)-1为C组,同时选取25名健康志愿者为D组。运用彩色多普勒超声检测患者颈动脉内中膜厚度(IMT)及肾内动脉血流阻力指数(RI)。同时获得颈动脉血管重构指标:血管重构发生率、重构类型(正重构、负重构、无重构)。结果组间比较A、B、C、D四组中,RI(F=3.873,P<0.05)及IMT(F=4.329,P<0.05)差异有统计学意义,其中A、B、C组RI及IMT均高于D组(P均<0.05),C组高于B组(P<0.05),B组高于A组(P<0.05);由Pearson相关分析得出,RI与IMT呈正相关关系(r=0.48,P<0.05),与eGFR呈负相关关系(r=-0.34,P<0.05);A组、B组、C组血管重构发生率均高于D组(P均<0.05),B组高于A组,C组高于B组(P均<0.05)。血管重构类型:A、B、C、D四组中负性重构随GFR降低逐渐递增,但只有C、D组差异有统计学意义(P均<0.05)。D组中血管重构类型以无重构为主,A、B、C组中血管重构类型均以正性重构为主;根据ROC曲线,RI>0.73为判定DN患者肾功能严重受损的截断参考值,其敏感性为81%,特异性为88%。在此参考值之上IMT明显增厚,差异有统计学意义(P<0.05)。结论彩色多普勒超声获取肾内动脉RI可评价糖尿病患者肾功能进展并反映其动脉粥样硬化情况,对糖尿病肾脏损害的早期诊断和动脉粥样硬化的预防有重要价值。

Objective To evaluate the abnormality of intra-renal arterial resistance index （RI） of the patients of type 2 diabetic nephropathy and its correlation with carotid artery atherosclerosis. Methods 62 subjects with type 2 diabetic nephropathy were enrolled and categorized into 3 groups according to GFR level： GFR≥90 ml .min-1 -（1.73 m2）-1 as group A（24 cases）, 60 ml .min-1 .（1.73 m2）-1≤〈GFR〈90 ml .min-1.（1.73 m2）-1 as group B（25 cases）, GFR〈60 ml .min-1（1.73 m2）-1 as group C（13 cases）. And, 25 healthy volunteers were recruited as the control group （group D）. The intra-renal arterial RI and carotid IMT were obtained by color Doppler ultrasonography. The vascular remodeling rate and remodeling types（without remodeling, positive remodeling and negative remodeling） of carotid artery were obtained. Results The differences of RI（F=3.873, P〈0.05） and IMT（F=4.329, P〈0.05） among four groups were significant, both IMT and RI of group A, B, C were significantly higher than those of group D（all P〈0.05）. Both IMT and KI of group C were higher than that of group B and group B were higher than that of group A（all P〈0.05）. RI was positive correlative with IMT（r=0.48, P〈 0.05）, and negative correlative with eGFR（r=-0.34, P〈0.05） respectively. The remodeling rate as well as negative remodeling were progressively increased as the GFR level rised. The remodeling rate of group D was lower than that of group A, B, C （all P〈0.05）, and group C were higher than that of group B while group B were higher than that of group A （all P〈0.05）. There was a significant difference only between group C and D in negative remodeling. Positive remodeling was dominant in group A, B and C whereas group C was mostly vessels without remodeling. A RI=0.73 was selected to be the cut-off point as an indicator of server renal damage in DNpatient. Subjects with RI above 0.73 had higher IMT than those with lower value（P〈0.05）. Conclusion The progress of renal function and atherosclerosis of the patients with type 2 diabetic nephropathy can be evaluated by intra-renal arterial RI obtained by color Doppler ultrasonography, and it plays an important role in early detection and prevention of renal injury and progress of atheroselerosis.