肾脏三维超声与糖尿病肾病肾组织病理改变的关联

Association of renal three-dimensional ultrasound and histopathological lesions in diabetic nephropathy patients

目的:分析肾脏三维超声参数与糖尿病肾病(DN)患者临床和肾组织病理改变的相关性。方法:选取2型糖尿病合并慢性肾脏病行肾活检明确肾脏病理诊断的患者110例,根据肾活检病理结果将其分为DN组62例、非糖尿病肾脏病变(NDRD)组48例,分析三维超声获得肾脏体积、肾皮质弹性剪切波速度(SWV)、肾血流灌注等参数,与两组患者临床资料及其肾小球病理分期、肾小管萎缩与间质纤维化(IFTA)等肾组织活检病理指标的关联,利用Logistic回归构建辅助诊断糖尿病肾病的预测模型。结果:DN组与NDRD组患者的年龄、糖尿病病程、总胆固醇、是否合并视网膜病变、是否有外周神经病变差异有统计学意义(P<0.05);DN组双肾体积大于NDRD组(左肾和右肾P值分别为0.084和0.009);双肾皮质弹性SWV值大于NDRD组(P<0.05),双肾血管指数(VI)和血管化血流指数(VFI)均低于NDRD组(P<0.05)。DN组肾小球病理分期3期和4期左肾SWV值显著高于2期(P<0.05),IFTA2级和IFTA3级患者左肾皮质SWV值显著高于IFTA1级(P<0.05)。将所有临床及超声资料参数进行共线性筛选,移除部分诊断效能低的参数,最终纳入年龄(AGE)、糖尿病病程(HIS)、是否合并视网膜病变(DR)、总胆固醇(TC)以及双肾皮质弹性均值(SWV^(—))来构建诊断DN的预测模型,所得方程为:Logit(DN)=0.67×AGE-0.113×HIS+1.710×DR+0.475×TC-3.538×SWV^(—)-1.937,ROC曲线下面积AUC=0.831,95%CI 0.752~0.910。结论:肾脏三维超声联合临床指标可为临床肾活检禁忌和高风险患者DN的诊断提供依据。

Objective:To analyze the correlation between renal three-dimensional(3 D)ultrasound parameters and pathological indicators in diabetic nephropathy patients.Methodology:A total of 110 patients with type 2 diabetes mellitus complicated with chronic kidney disease were selected and divided into DN group(n=62)and non-diabetic nephropathy group(n=48)according to pathological results of renal biopsy.The relationship between parameters such as renal volume,elastic shear wave velocity(SWV)and renal perfusion obtained by 3 D ultrasound and renal histopathological data of two groups was analyzed,including glomerular pathological staging,degree of interstitial fibrosis and tubular atrophy(IFTA),etc.The predictive model for auxiliary diagnosis of diabetic nephropathy was established by logistic regression.Results:There was statistically significant difference in age,course of diabetes mellitus,total cholesterol,retinopathy and peripheral neuropathy(P<0.05)between DN group and NDRD group.The volume of both kidncys in DN group was larger than that in NDRD group(The P value of left kidney and right kidney was 0.089 and 0.009 respectively).The SWV value of renal cortex in DN group was significantly higher than that in NDRD group(P<0.05),the SWV values of left renal cortex in IFTA2 and IFTA3 patients were significantly higher than those in IFTA1 group(P<0.05),also the SWV value of left kidney in glomerular pathological stage 3 and 4 was significantly higher than that in stage 2(P<0.05).The VI and VFI values of both kidneys in DN group were lower than those in NDRD group(P<0.05).All clinical and ultrasound data were included for linear filter,removing parameters with low diagnostic efficiency.AGE,diabetes duration(HIS),retinopathy(DR),total cholesterol(TC),and bilateral renal cortical elastic average(SWV^(-))were finally included to build the prediction model for diagnosis of DN:LogitLogit(DN)=0.67×AGE-0.113×HIS+1.710×DR+0.475×TC-3.538×SWV^(-)-1.937,area under ROC curve(AUC)=0.831,95%CI 0.752~0.910.Conclusion:The combination of renal 3 D ultrasound with clinical indicators is helpful for the diagnosis of diabetic nephropathy in patients with contraindications and high risks for renal biopsy.