声触诊组织定量早期诊断糖尿病肾病的价值

The value of virtual touch tissue quantification in early diagnosis of diabetic kidney disease

目的探讨声触诊组织定量(virtual touch tissue quantification,VTQ)成像早期诊断糖尿病肾病(diabetic kidney disease,DKD)的价值。方法纳入112例DKD患者和50例正常志愿者,均行常规超声、VTQ检查及相关生化检查,获得肾皮质剪切波速度(shear wave velocity,SWV)数据,ROC曲线进行统计学分析。结果 112例中DKD1期15例,DKD2期18例,DKD3期34例,DKD4期22例,DKD5期23例,SWV分别为:(2.42±0.20)m/s[范围:2.12~2.77m/s,95%CI:2.31~2.53m/s],(2.29±0.22)m/s[范围:1.97~2.65m/s,95%CI:2.18~2.40m/s],(2.14±0.18)m/s[范围:1.81~2.38m/s,95%CI:2.07~2.20m/s],(1.86±0.28)m/s[范围:1.39~2.30m/s,95%CI:1.73~1.99m/s],(1.31±0.21)m/s[范围:1.02~1.68m/s,95%CI:1.22~1.40m/s]。正常对照组50例,男26例,女24例;年龄25~82岁,平均55.64岁,SWV为(2.63±0.30)m/s[范围:2.10~3.19m/s,95%CI:2.54~2.72m/s]。经比较正常组与DKD1组P=0.0145,t=2.514,D2与D3:0.0084 2.746,D3与D4:<0.0001 4.462,D4与D5:<0.0001 7.390均有统计学意义,而D1与D2:0.0931 1.733无统计学意义。正常组与DKD组作ROC曲线得出截断值≤2.405m/s时,曲线下面积0.69,95%CI:0.53~0.86,P=0.02。VTQ判断DKD的敏感度87.50%,特异度76.00%,阳性似然比3.65,阴性似然比0.16,阳性预测值89.09%,阴性预测值73.08%,正确指数63.50%,一致率83.95%,Kappa值0.63(2=63.95,P<0.0001)。结论VTQ成像能够提供组织的定性及定量诊断弹性数据、反映其硬度,应用SWV测量DKD患者肾皮有较高的敏感度和特异度,在DKD早期诊断中具有一定价值。

Objective To investigate the value of virtual touch tissue quantification in early diagnosis of diabetic kidney disease （DKD）. Methods 112 patients with DKD and 50 normal volunteers were included, all underwent routine ultrasound, VTQ, and biochemical examinations, the shear wave velocity （SWV） data were obtained, and the ROC curve of the renal cortex SWV was analyzed statistically. Results Of the 112 patients with DKD, 15 were stage 1, 18 were stage 2, 34 were stage 3, 22 were stage, and 23 were stage 5 and, correspondingly, the SWV was （2.42± 0.20） m/s [ range： 2.12 - 2.77 m/s, 95% CI： 2. 31 -2.53 m/s], （2.29±0.22） m/s [range： 1.97 -2.65 m/s, 95%CI： 2.18 -2.40 m/s], （2.14±0.18） m/s [range： 1.81 -2.38 m/s, 95%CI：2.07-2.20 m/s], （1.86±0.28） m/s [range： 1.39 -2.30 m/s, 95%CI： 1.73 -1.99 m/s], and （ 1.31 ± 0.21 ） m/s [ range ： 1.02 - 1.68 m/s, 95% CI ： 1.22 - 1.40 m/s ], in each stage. As for the 50 normal volunteers, the SWV was （2.63±0.30） m/s [range： 2.10 -3.19 m/s, 95%CI： 2.54 -2.72 m/s]. The comparison of the SWV in normal group vs that in Stage 1 （ P =0.0145, t =2.514）, SWV in stage 2 vs that in Stage 3 （ P =0.0084, t =2.746）, SWV in stage 3 vs that in Stage 4 （ P 〈0.0001, t =4. 462）, and SWV in stage 4 vs that in Stage 5 （ P 〈0.0001, t =7. 390） showed statistically significant difference, but, SWV in stage 1 vs that in Stage 2 （ P = 0. 0931, t = 1. 733 ） had no significant difference. As the cut-off value of ROC in the normal group and DKD group was less than 2. 405 m/s, the area under the curve was 0. 69, 95%, CI：0.53 -0.86, P =0.02. When the VTQ was used to judge the DKD, the sensitivity was 87.50%, specificity was 76% , positive likelihood ratio was 3.65, negative likelihood ratio was 0.16, the positive predictive value was 89.09% , neg- ative predictive value was 73.08% , the correct index was 63.50% , consistency rate was 83.95% , Kappa value was 0.63 （χ^2 = 63.95, P 〈 0. 0001 ）. Conclusion VTQ imaging can provide qualitative and quantitative diagnosis of tissue elasticity data, re- flecting its hardness. The application of SWV in measurement of DKD patients with renal cortex has a high sensitivity and specificity, which has a certain value in the early diagnosis of DKD.