超声造影评估老年糖尿病患者肾皮质血流灌注的临床研究

Clinical value of contrast-enhanced ultrasonography in evaluating renal cortical perfusion in elderly diabetic patients

目的探讨超声造影（CEUS）评估老年糖尿病患者肾皮质血流灌注的临床应用价值。方法回顾性横断面研究，选取糖尿病合并慢性肾功能不全1～5期患者70例，依据肌酐水平估算肾小球滤过率（GFR），依据GFR分期将1～3期纳为轻、中度肾功能不全组42例，4～5期为重度肾功能不全组28例，所有患者行CEUS检查评估分肾血流灌注情况和核素分肾动态功能显像评估GFR。应用QLAB分析软件获取分肾的血流灌注时间-强度曲线及相关参数，包括曲线下面积、曲线上升支斜率、峰值强度、达峰时间。比较两组患者的分肾血流灌注参数的差异，应用Pearson相关性检验评估分肾皮质血流灌注定量参数与分肾GFR的相关性。结果轻、中度肾功能不全组和重度肾功能不全组患者年龄、男性比、高血压史、基础血糖、收缩压、舒张压等差异无统计学意义（均P〉0.05）。CEUS结果显示，轻、中度肾功能不全组患者表现为肾皮质血流高灌注；与重度肾功能不全组相比，其定量灌注参数曲线下面积、峰值强度、曲线上升支斜率、达峰时间差异有统计学意义（均P〈0.05）。同时，Pearson相关性检验提示，两组患者的分肾皮质血流灌注参数达峰时间、A均与GFR相关（右肾和左肾r值分别为－0.456和－0.693、0.432和－0.529，均P〈0.05），而曲线下面积、峰值强度与GFR均无相关性（右肾和左肾r值分别为均－0.003和－0.057、0.066和－0.081，均P〉0.05）。结论轻中度肾功能不全的糖尿病患者分肾皮质血流呈高灌注，CEUS可间接反映分肾功能，其中参数A与达峰时间与GFR有良好的相关性，因此CEUS可作为评估肾功能，特别是重度肾功能不全患者的安全、有效的方法，但仍需更多的研究结果验证。

ObjectiveTo investigate the clinical value of contrast-enhanced ultrasonography（CEUS）in evaluating renal cortical perfusion in elderly diabetic patients.MethodsA retrospective cross-sectional study was conducted.A total of 70 diabetic patients with chronic renal insufficiency stage 1 to 5 were enrolled.The glomerular filtration rate（GFR）was estimated according to the creatinine level.Based on GFR, patients were divided into a mild-to-moderate chronic kidney disease（CKD）group（n=42, CKD stage 1 to 3）and a severe CKD group（n=28, CKD stage 4 to 5）. All patients underwent CEUS for the assessment of renal perfusion and renal dynamic imaging for the assessment of GFR.QLAB analysis software was used to obtain the time-intensity curve（TIC）and related parameters including area under the curve（AUC）, the ascending slope（A）, the derived peak intensity（DPI）and the time to peak（TTP）. The differences in renal perfusion parameters were compared between the two groups.Pearson correlation test was used to assess the correlation between the quantitative parameters of renal cortical perfusion and GFR.ResultsThere was no significant difference in age, gender, history of hypertension, basal blood glucose level, systolic or diastolic blood pressure between the two groups（all P〉0.05）. CEUS findings revealed high renal cortical blood perfusion in the mild-to-moderate group.There were significant differences in quantitative perfusion parameters including AUC, DPI, A and TTP between the two groups.Pearson correlation test indicated that TTP and A were significantly correlated with GFR in both groups（r=-0.456 and -0.693, 0.432 and -0.529, all P〈0.05）, while AUC and DPI had no correlation with GFR（r=-0.003 and -0.057, 0.066 and -0.081, all P〉0.05）.ConclusionsDiabetic patients with mild-to-moderate CKD have high renal cortical blood perfusion.CEUS findings can indirectly reflect renal function.The perfusion parameters A and TTP have good correlations with GFR.CEUS can be used as a safe and effective method to evaluate renal function, especially in patients with severe renal insufficiency, but more studies are needed to verify the results.