急性肾盂肾炎CTP特点及与CRP、糖尿病的相关性

The CTP Characteristics of Acute Pyelonephritis and Its Relationship with CRP and Diabetes:A Correlation Study

目的探讨急性肾盂肾炎（APN）血流灌注变化特点及其与超敏C-反应蛋白（hs-CRP）的相关性,并观察糖尿病（DM）与非糖尿病（n DM）APN患者CT灌注成像（CTP）参数是否存在差异。方法 30例APN行全肾CTP,测量APN病灶与对侧正常肾皮质血流量（BF）、血容量（BV）、平均通过时间（MTT）及达峰时间（TTP）,并记录CTP检查12 h内hs-CRP水平与是否合并糖尿病。采用两独立样本比较的Wilcoxon符号秩检验分析APN病灶与对侧正常肾皮质之间各灌注参数,采用Pearson相关及线性回归分析APN病灶各灌注参数与hs-CRP的相关性,采用两独立样本t检验及Wilcoxon符号秩检验比较DM与n DM组APN各灌注参数及hs-CRP。结果 APN病灶与对侧正常肾皮质各灌注参数之间差异显著（BF：65.97±21.16与412.36±84.62 ml·min^-1·100g^-1,Z=-6.064,P〈0.001;BV：13.91±2.95与33.42±4.90 ml/100g,Z=-6.063,P〈0.001;MTT：11.88±2.47与5.97±0.88 S,Z=-5.908,P〈0.001;TTP：33.08±4.10与13.92±1.99 s,Z=-6.064,P〈0.001）;APN病灶BF与hs-CRP呈负相关（r=-0.566,P=0.001）,而APN病灶MTT及TTP与hs-CRP呈正相关（r=0.386,P=0.035;r=0.446,P=0.014）,但APN病灶BV与hs-CRP无相关性（r=-0.218,P=0.248）。DM与n DM组APN病灶BF及BV差异显著（BF：57.87±15.26与76.29±23.73 ml·min^-1·100g^-1;BV：12.76±2.56与15.38±2.85 ml/100g,Z=-2.409,P=0.016）,而MTT及TTP无显著性差异（t=0.632,P=0.533;Z=-0.602,P=0.547）,DM与n DM组hs-CRP差异明显（hs-CRP：70.89±18.72与47.25±18.46 mg/L,t=-3.473,P=0.002）。结论 APN的血流灌注明显下降、循环时间延长,且灌注参数与hs-CRP之间有一定相关性;DM与n DM组血流灌注差异显著,提示CTP可反映APN的炎症反应程度。

Objective To explore the correlation between CTP characteristics of acute pyelonephritis （APN） and hypersensitive C reaction protein （hs-CRP） and observe whether there is a difference in CTP parameters between diabetes mellitus （DM） and nondiabetes mellitus （nDM） patients with APN. Methods 9 Thirty consecutive refractory APN were performed with CTP scans using VHS mode. Perfusion parameters including blood flow （BF） , blood volume （BV） , mean transit time （MTT） and time to peak （TrP） in APN lesions and the contralateral normal renal cortex were measured. The level of hs-CRP within 12 b after admission to hospital, as well as whether these patients were diabetic or not, were recor- ded. The differences of perfusion parameters in APN lesions and the contralateral normal kidney were analysed by Wilcoxon signed rank test. Pearson correlation analysis and linear regression were performed to explore the associations between CTP parameters of APN lesions with hs-CRP. APN perfusion parameters and hs-CRP in DM and nDM group were compared by two independent sample t test and Wileoxon signed rank test. Results There were significant difference for BF, BV, MTT and 3~FP between APN lesions and the eontralateral normal renal cortex （ BF：65.97 - 21.16 vs 412.36 ± 84.62 ml·min^-1·100g^-1 ,Z = -6. 064,P 〈0.001 ; BV- 13.91 ~2.95 vs 33.42 - 4.90 ml/100g,Z = - 6. 063 ,P 〈 0. 001 ; MTY： 11.88 ＋2.47 vs 5.97 ＋0.88 S,Z= -5.908,P〈0.001; TYP：33.08 ＋4.10 vs 13.92_-1.99 S,Z= -6. 064,P〈0. 001） ;BF of APN lesions were negatively correlated with hs-CRP （r = -0. 566, P = 0. 001 ）, while MTF and TI＇P showed a positive correlation with hs-CRP（ r = 0. 386,P = 0. 035; r = 0. 446,P = 0. 014）. Whereas there was no correlation between B V and hs-CRP（r = -0. 218 ,P = 0. 248）. There was significant difference in BF and BV of APN lesions between DM and uDM groups（ BF：57. 87 ＋ 15.26 vs 76.29 ＋ 23.73ml·min^-1·100^-1 ,BV： 12.76 - 2.56 vs 15.38 ± 2.85 ml/100g,Z = -2. 409, P = 0.016） , but there was no significant difference of MTT and TTP between APN lesions （t = 0. 632, P = 0. 533 ; Z = -0. 602 ,P = 0. 547 ）and normal kidney. There was significant difference in hs-CRP between DM and nDM groups （ hs-CRP：70.89 _＋ 18.72 vs 47.25 ±18.46 mg/L, t = - 3. 473,P = 0. 002）. Conclusion The CTP characteristics of APN include lower blood perfusion and prolonged circulation time, There is certain correlation between the perfusion parameters and the value of hs-CRP. There＇ s a significant difference of perfusion parameters between DM and nDM APN groups. Thus, CTP parameters can reflect the degree of inflammation of APN.