摘要
目的:探讨彩色多普勒超声参数[收缩期峰值血流速(PSV)、舒张末期血流速度(EDV)、血管阻力指数(RI)]评估肾动脉血流变化与平均血小板体积(MPV)及血小板分布宽度(PDW)对早期2型糖尿病肾病(DKD)的诊断价值。方法:选取医院收治的121例2型糖尿病(T2DM)患者,根据尿白蛋白与肌酐比值(UACR)水平将其分别纳入单纯糖尿病(DM)组(43例,UACR<30 mg/g)、早期2型DKD组(40例,UACR30~300 mg/g)和2型DKD组(38例,UACR>300 mg/g);另选取同期体检的42名健康体检者纳入健康对照组。对比4组肾动脉血流指标、MPV、PDW、同型半胱氨酸(Hcy)、纤维蛋白原(Fib)和胱抑素C(Cys-C);采用多项Logistic回归模型分析影响T2DM患者并发肾病的相关影响因素;评估血流收缩期峰值速度(PSV)、舒张末期血流速度(EDV)、阻力指数(RI)、MPV、PDW和5项联合早期诊断T2DKD的受试者工作特征(ROC)曲线下面积(AUC)值、灵敏度及特异度。结果:4组在肾主动脉(MRA)、肾段动脉(SRA)及叶间肾动脉(IRA)等部位的PSV、EDV及RI比较,差异均有统计学意义(FMRA=8.051,F=58.578,F=9.814;FSRA=7.773,F=52.292,F=7.745;FIRA=11.891,F=87.970,F=9.669;P<0.05)。4组的MPV、PDW、Hcy、Fib和Cys-C比较,差异有统计学意义(F=29.239,F=21.078,F=16.179,F=46.443,F=42.143;P<0.05)。Logistic回归分析显示,PSV、EDV、RI、MPV、PDW、Hcy、Fib和CysC是T2DM患者并发肾病的独立影响因素(OR=0.957,OR=0.703,OR=19.164,OR=1.345,OR=1.287,OR=1.146,OR=3.988,OR=822.068;P<0.05)。ROC曲线分析中,PSV、EDV、RI、MPV、PDW和5项联合诊断2型DKD的AUC分别为0.698、0.859、0.729、0.794、0.759和0.944。结论:超声参数与MPV、PDW在早期2型DKD诊断中具有较高的临床价值,且联合应用诊断价值更高,可为诊治提供重要依据。
Objective: To investigate the diagnostic values of color Doppler ultrasound parameters [peak systolic velocity(PSV) of blood flow, end-diastolic velocity(EDV) of blood flow, vascular resistance index(RI)] in assessing the changes of blood flow of renal artery, and in assessing mean platelet volume(MPV) and platelet distribution width(PDW) for early type 2 diabetic kidney disease(DKD). Methods: 121 patients with type 2 diabetes mellitus(T2DM)were enrolled into this study, and they were divided into simple diabetes mellitus(DM) group(43 cases, UACR < 30mg/g), early type 2 DKD group(40 cases, UACR 30-300 mg/g) and type 2 DKD group(38 cases, UACR > 30 mg/g)according to urinary albumin to creatinine ratio(UACR). 42 healthy subjects who underwent physical examination during the same period were included in the healthy control group. The blood flow indexes of renal artery, MPV, PDW,homocysteine(Hcy), fibrinogen(Fib) and cystatin C(Cys-C) among the 4 groups were compared. Multiple Logistic regression model was used to analyze the related influencing factors that affected the complicated nephropathy of patients with T2DM. The area under curve(AUC) values of receiver operating characteristics(ROC), sensitivities and specificities of peak systolic velocity(PSV) of blood flow, end-diastolic velocity(EDV) of blood flow, resistance index(RI), MPV, PDW, and the combined diagnosis of above 5 indicators were assessed in diagnosing type 2 DKD at early stage. Results: There were significant differences in PSV, EDV and RI of main renal artery(MRA), segmental renal artery(SRA) and interlobares renal artery(IRA) among the 4 groups(FMRA=8.051, F=58.578, F=9.814, FSRA=7.773,F=52.292, F=7.745, FIRA=11.891, F=87.970, F=9.669, P<0.05), respectively. The differences of MPV, PDW, Hcy, Fib and Cys-C among the 4 groups were significantly different(F=29.239, F=21.078, F=16.179, F=46.443, F=42.143,P<0.05), respectively. The results of logistic regression analysis showed that PSV, EDV, RI, MPV, PDW, Hcy, Fib and CysC were respectively independent influencing factor of complicated nephropathy of T2DM patients(OR=0.957,OR=0.703, OR=19.164, OR=1.345, OR=1.287, OR=1.146, OR=3.988, OR=822.068, P<0.05). In ROC curve analysis,the AUCs of PSV, EDV, RI, MPV, PDW and the combined diagnoses of the 5 indicators were 0.698, 0.859, 0.729, 0.794,0.759 and 0.944 in diagnosing type 2 DKD, respectively. Conclusion: Ultrasound parameters, MPV and PDW have higher clinical value in the early diagnosis of type 2 DKD, and the diagnostic value of the combined application of them would be higher, which can provide important basis for diagnosis and treatment.
作者
何博
陈日超
易莉娜
雷芳
黄宝华
范先英
HE Bo;CHEN Richao;YI Li-na(General Medicine Department,The Second Affiliated Hospital of Guilin Medical University,Guilin 541100,China.)
出处
《中国医学装备》
2023年第2期82-87,共6页
China Medical Equipment
基金
广西壮族自治区卫生健康委员会科研项目(Z20211634)“平均血小板体积、血小板分布宽度联合彩色多普勒对早期2型糖尿病肾病的诊断价值”。
