应用剪切波弹性成像技术研究糖尿病肾病患者肾组织弹性

Application of shear wave elastography in the study of renal tissue elasticity in patients with diabetic nephropathy

目的应用实时剪切波弹性成像（SWE）技术定量分析不同分期糖尿病肾病（diabetic nephropathu，DN）患者肾实质的弹性，探讨SWE技术在早期诊断DN中的价值。方法选取2型糖尿病患者155例为DN组，年龄、性别相匹配的健康志愿者54例为对照组。依据糖尿病Mogensen分期标准，按尿蛋白／肌酐（ACR）将DN组分为3组：A组（单纯糖尿病或DNⅠ、Ⅱ期），ACR〈30mg／g，60例；B组（DNⅢ期），ACR30-300mg／g，43例；C组（DNⅣ、Ⅴ期），ACR〉300mg／g，52例。所有受试者均应用SWE技术检测左肾中部肾实质最大弹杨氏模量值（Emax）、平均杨氏模量值（Emean）、最小杨氏模量值（Emin）。结果①DN组患者肾实质Emax、Emean、Emin均大于对照组（P〈0．05）。A、B、C组肾实质硬度有逐渐增加趋势（P〈0．05）。②DN肾实质Emax、Emean、Emin与ACR均呈正相关（r=0．817，0．764，0．609；均P=0．000）。③Emax诊断DNⅢ期的曲线下面积为0．810，截点值为6．65kPa，敏感性79．0％，特异性81．7％；Emean诊断DNⅢ期的曲线下面积为0．785，截点值为3．69kPa，敏感性62．8％，特异性78．3％。结论SWE技术可分析DN患者肾实质弹性，肾实质杨氏模量值有助于区分DNⅢ期与其他各组之间的差异，为早期诊断DN提供了新的诊断信息。

Objective To investigate the clinical value of real-time shear wave elastography（SWE） in early diagnosis of diabetic nephropathy（DN）. Methods One hundred and fifty-five patients with type 2 diabetes mellitus （DM） in our hospital were selected as DN group and 54 healthy volunteers with matched age-sex were selected as control group. According to the criteria of Mogensen staging, patients of DN group were divided into 3 subgroups according to urine protein/creatinine （ACR）：group A （DM or DN Ⅰ , Ⅱ ）, ACRe30 mg/g; group B （DN Ⅲ ）, ACR 30 - 300 mg/g; group C （DN IV, V ）, ACRe300 mg/g. All subjects were examined by SWE technique to detect the maximum, mean and minimum Young＇ s modulus values （Emax, Emean, Emin） of the middle of left renal parenchyma, the values of Young＇s modulus in the control group and DN patients were compared. The relationship between Young＇s modulus and ACR in patients with DN was analyzed. Results The Emax, Emean and Emin in DN patients were all greater than those in control group （ P 〈0.05）. In group A, B and C, Emax, Emean and Emin gradually increased （P〈 0.05）. Spearman correlation analysis showed that there was a positive correlation between Young＇ s modulus and ACR in patients with DN （r = 0.817,0.764,0.609;all P= 0.000）. ROC curve analysis showed that the area under the curve of Emax diagnosis DN Ⅲ stage was 0. 810, the cut-point value was 6.65 kPa,the sensitivity was 79.0%, and the specificity was 81.7%;the area under the curve of Emean diagnosis DN Ⅲ stage was 0. 785, and the cut-off value was 3.69 kPa, sensitivity 62.8%, specificity 78.3%. Conclusions SWE technique can quantitatively analyze renal parenchyma hardness in patients with different stages of DN, which may provide new diagnostic information for early diagnosis of DN.