不同时期糖尿病肾病患者肾脏超声检查的比较

Comparative analysis of renal ultrasonogram of patients with diabetic nephropathy at different stages

目的比较不同时期糖尿病肾病（DN）患者各项肾脏超声检查指标的区别,探讨彩色多普勒超声检查在DN诊断中的临床价值。方法选取2013年8月-2014年8月该院门诊收治的糖尿病（DM）患者189例,按尿白蛋白排泄率（UAER）将其分为3组,A组：间断微量白蛋白尿（UAE）（UAE〈20μg/min或〈30 mg/24 h）;B组：UAE持续20~200μg/min或30~300 mg/24 h;C组：UAE持续〉200μg/min或〉300 mg/24 h。同时选取50例健康受试者作为对照组。对各期DM患者和对照组受试者,行多普勒肾脏超声检查。结果多普勒肾脏超声检查,A组肾脏长径与对照组比较,差异有统计学意义（P〈0.05）;B组皮质厚度、髓质厚度与对照组比较,差异有统计学意义（P〈0.05）;C组肾脏长径、皮质厚度及髓质厚度与对照组比较,差异有统计学意义（P〈0.01）。A组主动脉、段动脉的阻力指数（RI）与对照组比较,差异有统计学意义（P〈0.05）;B组主动脉、段动脉的动脉收缩期峰值速度（PSV）、舒张末期流速（EDV）及RI及搏动指数（PI）与对照组比较,差异有统计学意义（P〈0.05）;C组主动脉、段动脉的PSV、EDV、RI及PI与对照组比较,差异有统计学意义（P〈0.01）。A、B组肾血流量与对照组比较,差异无统计学意义（P〉0.05）;C组肾血流量与对照组比较,差异有统计学意义（P〈0.01）。结论 DN患者的临床进展与肾脏超声检查指标密切相关。通过对DN患者行肾脏彩色多普勒超声检查,能够反应不同时期DN患者肾脏大小、血流灌注及肾血流动力学变化,能早期确定DN患者的肾脏损害程度,对指导治疗和预后评估具有重要意义。

【Objective】 To analyze the difference of renal ultrasonogram among the patients with diabetic nephropathy（DN） at different stages and to analyze the clinical value of color Doppler ultrasonography in the diagnosis of diabetic nephropathy. 【Methods】 A total of 189 patients with diabetic mellitus（DM） were selected, including group A（UAER 〈 20 μg/min or 〈 30 mg / 24 h）, group B（UAER 20~200 μg/min or 30~300 mg/24 h） and group C（UAER 〉 200 μg/min or 〉 300 mg / 24 h）. And 50 health cases were selected as control group. The renal ultrasonography was used in all the patients with DN and the control subjects. 【Results】There was a significant difference in the renal diameter between the patients of the group A and the subjects of the control group（P 〈 0.05）. There were significant differences in the thickness of cortex and medulla between the patients of the group B and the control subjects（P 〈 0.05）. There were significant differences in the renal diameter and the thickness of cortex and medulla between the patients of the group C and the control subjects（P 〈 0.01）. There were significant differences in the resistive index（RI） of aorta and segmental arteries between the patients of the group A and the control subjects（P 〈 0.05）. There were significant differences in the PSV, EDV, RI and pulsatility index（PI） of aorta and segmental arteries between the group B and the control group（P 〈 0.05）. There were significant differences in the PSV, EDV, RI and PI of aorta and segmental arteries between the group C and the control group（P 〈 0.01）. There was no difference in the renal blood flow between the group A or B and the control group（P 〉 0.05）. There was a significant difference in the renal blood flow between the group C and the control group（P 〈 0.05）. 【Conclusions】 Clinical progression in the patients with DN is closely related with the indexes of renal ultrasonography. By renal ultrasonography,the changes of kidney structure, perfusion of blood flow and renal hemodynamic changes of the patients with diabetic nephropathy could be found. Renal ultrasonography can help to determine the extent of renal damage of diabetic nephropathy patients and provide the guidance for the treatment and evaluation of diabetic mellitus.