核素肾动态显像联合实验室指标预测糖尿病肾病患者预后的价值

Prognostic Value of Radionuclide Renal Dynamic Imaging Combined with Laboratory Parameters in Patients with Diabetic Nephropathy

目的探讨二乙三胺五乙酸(^(99m)Tc-DTPA)核素肾动态显像联合实验室指标预测糖尿病肾病(DN)患者预后的价值。方法回顾性分析2018年6月-2019年6月收治的120例DN的临床资料,根据患者治疗12个月后是否发生终点事件分为预后良好组84例和预后不良组36例。收集2组入院时一般资料及血尿素(BUN)、血肌酐(Scr)、24 h尿蛋白、尿微量白蛋白(mALb)等实验室指标,采用^(99m)Tc-DTPA核素肾动态显像技术测定肾小球滤过率(GFR)。应用受试者工作特征(ROC)曲线分析BUN、Scr、24 h尿蛋白、mALb、GFR对DN患者预后不良的预测价值。采用多因素Logistic回归分析探讨DN患者预后不良的危险因素。最后通过一致性分析,评估BUN、Scr、24 h尿蛋白、mALb联合GFR对DN患者预后不良的预测价值。结果预后不良组年龄≥60岁患者占比及BUN、Scr、24 h尿蛋白、mALb显著高于对照组,GFR显著低于对照组(P<0.05,P<0.01)。BUN、Scr、24 h尿蛋白、mALb、GFR预测DN患者预后不良的ROC曲线下面积分别为0.735、0.809、0.851、0.899、0.936。多因素Logistic回归分析证实,年龄≥60岁、BUN≥6.48 mmol/L、Scr≥77.13μmol/L、24 h尿蛋白≥2.28 g/d、mALb≥76.65 mg/d、GFR<83.62 ml/(min·1.73 m 2)是DN患者预后不良的危险因素(P<0.01)。经一致性分析,120例DN中BUN、Scr、24 h尿蛋白、mALb、GFR联合预测预后不良35例,敏感度为0.972,特异度为0.964,准确率为0.967,Kappa为0.922。结论核素肾动态显像和BUN、Scr、24 h尿蛋白、mALb、GFR均可用于预测DN患者预后,且联合检测可获得更高的敏感度、特异度。

Objective To investigate the value of diethylenetriaminepentaacetic acid(^(99m)Tc-DTPA)radionuclide dynamic imaging combined with laboratory parameters in predicting the prognosis of patients with diabetic nephropathy(DN).Methods The clinical data of 120 cases of DN in our hospital from June 2018 to June 2019 were retrospectively analyzed.According to presence of end-point events at 12 months after treatment,they were divided into the good prognosis group(n=84)and the poor prognosis group(n=36).The general data and laboratory parameters such as blood urea nitrogen(BUN),serum creatinine(Scr),24-hour urinary protein,and urine microalbumin(mALb)were collected in the two groups at admission.Glomerular filtration rate(GFR)was determined by ^(99m)Tc-DTPA radionuclide renal dynamic imaging technique.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of BUN,Scr,24-hour urinary protein,mALb,and GFR for poor prognosis in patients with DN.Multivariate Logistic regression analysis was used to explore the risk factors of poor prognosis in DN patients.Finally,the predictive value of BUN,Scr,24-hour urinary protein,mALb combined with GFR in the poor prognosis of DN patients was evaluated by consistency analysis.Results The proportion of patients aged≥60 years,BUN,Scr,24-hour urinary protein and mALb in the poor prognosis group were significantly higher than those in the control group,while the GFR was significantly lower than that in the control group(P<0.05,P<0.01).The areas under the ROC curve of BUN,Scr,24-hour urinary protein,mALb,and GFR for predicting poor prognosis in DN patients were 0.735,0.809,0.851,0.899,and 0.936,respectively.Multivariate Logistic regression analysis confirmed that age≥60 years,BUN≥6.48 mmol/L,Scr≥77.13μmol/L,24-hour urinary protein≥2.28 g/d,mALb≥76.65 mg/d,GFR<83.62 ml/(min·1.73 m 2)were risk factors for poor prognosis in DN patients(P<0.01).Consistency analysis showed that among the 120 patients with DN,there were 35 patients after combined detection of BUN,Scr,24 h urinary protein,mALb and GFR in predicting poor prognosis,with a sensitivity of 0.972,a specificity of 0.964,an accuracy of 0.967,and a Kappa of 0.922.Conclusion Radionuclide renal dynamic imaging,BUN,Scr,24-hour urinary protein,mALb and GFR can be used to predict the prognosis of DN patients,and the combined detection can achieve higher sensitivity and specificity.