肾脏缺氧分数联合血清VEGF对肾脏组织内缺氧的临床意义

Clinical significance of renal hypoxia fraction combined with serum VEGF in renal tissue hypoxia

目的探讨肾脏缺氧分数联合血清血管内皮生长因子(VEGF)对肾脏组织内缺氧的临床意义。方法选取该院2017年1月至2018年1月收治的慢性肾脏疾病患者56例,按照《KDIGO慢性肾脏病评价及管理临床实践指南》分为轻度组(Ⅰ~Ⅱ期,27例)、中重度组(Ⅲ~Ⅳ期,29例),选择同期到该院体检为健康者26例作为对照组;所有入选者采用核磁共振成像检查,检测血清VEGF水平变化,采用感兴趣区域(ROI)法与肾脏缺氧分数方法计算图像数据,同时比较ROI法与肾脏缺氧分数联合血清VEGF的效能。结果对照组、轻度组及中重度组患者髓质R2*值显著高于皮质R2*(P<0.05);对照组与轻度组皮质R2*值差异无统计学意义(P>0.05);对照组与中重度组、轻度组与中重度组比较差异有统计学意义(P<0.05);与对照组比较,轻度组、中重度组髓质R2*不断升高,各组间差异具有统计学意义(P<0.05);与对照组比较,轻度组、中重度组肾脏缺氧分数、血清VEGF明显升高(P<0.05);与轻度组比较,中重度组肾脏缺氧分数、血清VEGF明显升高(P<0.05);经受试者工作特征(ROC)曲线分析,肾脏缺氧分数联合血清VEGF的AUC为0.961,其灵敏度与特异度均高于髓质R2*;采用Alpha信度系数法,肾脏缺氧分数联合血清VEGF的灵敏度(0.959)大于髓质R2*(0.857)。结论肾脏缺氧分数联合血清VEGF对肾脏组织内缺氧检测的灵敏度更高,可重复性更高,可有效评估肾脏的氧化情况。

Objective To investigate the clinical significance of renal hypoxia fraction combined with serum vascular endothelial growth factor(VEGF)in renal tissue hypoxia.Methods A total of 56 patients with chronic kidney disease admitted to the hospital from January 2017 to January 2018 were selected and divided into the mild groups(phaseⅠ-Ⅱ,27 cases)and moderate-to-severe group(phaseⅢ-Ⅳ,29 cases)according to KDIGO Chronic Kidney Disease Evaluation and Management Clinical Practice Guidelines;meanwhile 26 subjects undergoing the healthy physical examination in the hospital were selected as the control group.All cases were examined by magnetic resonance imaging(BOLD-MRI)and the changes of serum VEGF were detected.The ROI method and renal hypoxia fraction method were used to calculate the image data.The ROI method and renal hypoxia fraction method combined with serum VEGF were compared.Results The medulla R2*values in the control group,mild group and moderate-to-severe group were significantly higher than those in the cortical R2*(P<0.05);there was no statistically significant difference in the R2*value between the control group and the mild group(P>0.05);there were statistically significant differences between the normal group and the moderate-to-severe group as well as the mild group and the moderate-to-severe group(P<0.05).Compared with the control group,the medulla R2*in the mild group and moderate-to-severe group was increased continuously,and the difference among the groups was statistically significant(P<0.05).Compared with the control group,the renal hypoxia score and serum VEGF in the mild group and moderate-to-severe group were significantly increased(P<0.05);compared with the mild group,the renal hypoxia fraction and serum VEGF in the moderate-to-severe group were significantly increased(P<0.05).The ROC curve analysis showed that the renal hypoxia fraction combined with serum VEGF had AUC of 0.961,and its sensitivity and specificity were higher than those of medulla R2*.The Alpha reliability coefficient method adopted,AUC of the renal hypoxia fraction combined with serum VEGF was greater than that the medulla R2*(0.959 vs.0.857).Conclusion The renal hypoxia fraction combined with serum VEGF is more sensitive to hypoxia detection in renal tissues and is highly reproducible,which can effectively evaluate the renal oxidation.