超声造影参数在糖尿病肾病K-W结节形成中的评估价值

Value of Contrast-enhanced Ultrasound Parameters in Evaluating K-W Nodule Formation in Diabetic Nephropathy

目的探讨超声造影(CEUS)参数在糖尿病肾病(DN)K-W结节形成中的评估价值。方法收集2017年3月至2020年1月在中国人民解放军总医院第一医学中心行CEUS且病理诊断为DN的患者62例,根据有无K-W结节形成分为两组,分析两组间肾脏皮质CEUS参数及皮髓质CEUS参数比值间的差异。结果62例DN患者中,无K-W结节组19例,K-W结节组43例。皮质CEUS参数中,K-W结节组的时间相关参数中位上升时间(U=209,P=0.013)和下降时间(U=197,P=0.007)明显长于无K-W结节组;血流灌注相关参数中位流入相比率(WiR)(U=228,P=0.031)和流出相比率(WoR)(U=229,P=0.032)明显小于无K-W结节组。皮质与髓质CEUS参数比值中,K-W结节组的中位峰值强度(PE)1/PE2(U=224,P=0.026)、WiR1/WiR2(U=235,P=0.041)和WoR1/WoR2(U=230,P=0.043)明显小于无K-W结节组;中位FT1/FT2明显大于无K-W结节组(U=227,P=0.038)。结论CEUS参数可对K-W结节形成的DN患者肾脏皮质微血流灌注情况进行定量评估。

Objective To discuss the value of contrast-enhanced ultrasound(CEUS)parameters in evaluating the formation of Kimmelstiel-Wilson(K-W)nodules in diabetic nephropathy(DN).Methods Sixty-two patients pathologically diagnosed with DN and undergoing CEUS in the First Medical Center of Chinese PLA General Hospital from March 2017 to January 2020 were assigned into two groups according to whether K-W nodules were formed.The cortical CEUS parameters and the ratios of cortical to medullary CEUS parameters were compared between the two groups.Results The 62 patients included 19 patients without K-W nodules(group A)and 43 patients with K-W nodules(group B).The median rise time(U=209,P=0.013)and fall time(U=197,P=0.007)in group B were significantly longer than those in group A.The median wash-in rate(WiR)(U=228,P=0.031)and wash-out rate(WoR)(U=229,P=0.032)in group B were significantly lower than those in group A.The median peak enhancement(PE)1/PE2(U=224,P=0.026),WiR1/WiR2(U=235,P=0.041),and WoR1/WoR2(U=230,P=0.043)ratios in group B were significantly lower than those in group A.The median FT1/FT2 ratio in group B was significantly higher than that in group A(U=227,P=0.038).Conclusion CEUS parameters can be used to quantitatively evaluate renal cortical microperfusion in DN patients with K-W nodules.