糖尿病肾病1～4期临床特点观察及彩色多普勒超声诊断分析

Observation on the Clinical Characteristics of Diabetic Nephropathy from One to Four Stage and the Analysis of Color Doppler Ultrasound Diagnosis

目的探讨糖尿病肾病的临床特征以及分析彩色多普勒超声检查在糖尿病肾病（DN）诊断中的临床价值。方法选取该院1~4期DN患者100例,按24 h尿蛋白排泄率（UAER）水平分为3组：A组（〈30 mg/24 h）、B组（30~300 mg/24 h）和C组（〉300 mg/24 h）。另选取30例健康人群作为对照组（D组）。采用彩色多普勒超声检测所有患者的肾脏大小、血流速度及各级动脉血流动力学参数。结果 A、B、C组患者肾脏大小与较D组明显增加,差异有统计学意义（P〈0.01）。B、C组各级动脉的搏动指数（PI）、阻力指数（RI）较A、D组均明显增高;收缩期最大血流速度（Vmax）、舒张期最低血流速度（Vmin）均明显降低,差异有统计学意义（P〈0.05）;A组各级血流频谱参数较D组差异无统计学意义（P〉0.05）。DN从1~4期,肾血流显像逐渐减少,A、D组为1级或2级,B组为3级,C组为4级。结论 DN患者的临床进展与UAER的水平密切相关。彩色多普勒超声能反应DN患者肾脏大小、血流灌注和肾血流动力学变化,对DN患者的诊断具有重要的临床意义。

Objective To observe the clinical characteristics of diabetic nephropathy and analyze the clinical value of color Doppler ultrasound in the diagnosis of diabetic nephropathy（DN）. Methods 100 cases with diabetic nephropathy from one to four stage admitted in our hospital were classified into three groups according to the urinary albumin excretion rate（UAER） all day： Group A（30mg/24h）, group B（30-300mg/24h） and group C（300mg/24h）.And 30 normal persons were selected as controls（group D）. Color Doppler ultrasound was used to detect the kidney size, blood flow velocity and various parameters of hemodynamics of all the patients. Results Compared with group D, the renal size of group A, group B and group C were much larger, the difference was statistically significant（P〈0.01）. Compared with group A and D, the pulsatility index（PI） and resistance index（RI） of renal arteries of patients in group B and C were much higher; The systolic Vmax and diastolic Vmin were lower, the differences were statistically significant（P〈0.05）.There were no significant differences in the flow parameters between group A and group D（P〉0.05）. From one to four stage of DN, gradual reduction in renal blood flow imaging, group A and D reached 1 level or 2 levels, group B reached 3 levels, group C reached 4 levels. Conclusion Clinical progression in patients with DN is closely related with the level of UAER. Color Doppler ultrasound can show the kidney size of patients with DN, perfusion and renal hemodynamic changes, which has important clinical significance for the diagnosis of patients with DN.