2型糖尿病患者肾功能损伤及氧合水平的BOLD MRI分析

A BOLD MRI study of renal oxygenation levels in type2 diabetic patients with renal impairment

目的 探讨采用血氧水平依赖磁共振成像(BOLD MRI)技术分析2型糖尿病(diabetes mellitus type2,T2DM)患者的估算肾小球滤过率(estimated glomerular filtration rate,eGFR)不同水平的肾缺氧改变。方法 选取T2DM患者以及同期健康正常者共78例,其中64例T2DM患者作为T2DM组,14例同期健康正常者作为对照组,均进行BOLD MRI检查。根据eGFR将64例T2DM患者又分为eGFR正常组(A组)、轻度功能损害组(B组)、中重度肾功能损害组(C组),测定肾脏髓质、皮质R2*(MR2*、CR2*)。采用单因素方差分析数据MR2*、CR2*的组间差异及其与eGFR的相关性,并采用受试者工作特征曲线(receiver operating characteristic cure, ROC)分析MR2*、CR2*值的诊断效能。结果 与对照组相比,A、B、C组MR2*、CR2*值均显著升高,差异有统计学意义(P均<0.05),均与eGFR呈正相关(P均<0.05),均可鉴别T2DM组与对照组,但MR2*值的鉴别敏感度稍高。结论 BOLD MRI可无创评估T2DM患者早期肾脏功能性缺氧改变,监测eGFR不同阶段的肾脏氧合水平,对临床治疗具有指导意义。

Objective To investigate the changes in renal hypoxia at different levels of estimated glomerular filtration rate(eGFR)in patients with type 2 diabetes by BOLD MRI.Methods 64 patients with type 2 diabetes mellitus(DM group)and 14 normal controls(NC group)underwent BOLD MRI examination.According to eGFR,diabetic patients were divided into nor‐mal eGFR group(group A),mild and moderate to severe renal impairment group(group B and group C).Renal medullary R2*(MR R2*)and cortical R2*(CR2*)were measured.The inter-group differences of MR2*and CR2*were analyzed by one-way ANOVA.The relationship was analyzed between R2*and eGFR values and the receiver operating characteristic curve was used to assess the MR2*and CR2*values on renal function impairment in patients with type 2 diabetes.Results Compared with the NC group,the values of medullary R2*and cortical R2*in groups A,B and C were significantly increased(all P<0.05),and were positively correlated with eGFR(all P<0.05).MR2*and CR2*values may identify type 2 diabetic patients from normal controls,but the sensitivity of the MR2*value was slightly higher.Conclusion BOLD MRI can noninvasively evaluate the early renal functional hypoxia changes in diabetic patients and monitor the renal oxygenation level at different stages of eGFR,which has guiding significance for clinical treatment.