中国现代医学杂志2025，Vol.35Issue(15)：7-15,9.DOI:10.3969/j.issn.1005-8982.2025.15.002
超声造影技术评估糖尿病肾病肾脏血流灌注的应用价值
Application value of contrast-enhanced ultrasonography in assessing renal blood perfusion in diabetic nephropathy
摘要
Abstract
Objective To investigate characteristic changes in renal blood perfusion at different stages of diabetic nephropathy(DN)and evaluate the clinical value of contrast-enhanced ultrasonography(CEUS),specifically analyzing the wash-in rate(WiR).Methods Fifty-five diabetes mellitus(DM)patients were enrolled between February 2024 and January 2025 and categorized into DM group(normoalbuminuria,n=13),early DN group(microalbuminuria,n=28),and clinical DN group(macroalbuminuria,n=14)based on urinary albumin-to-creatinine ratio(UACR).Six healthy subjects served as controls.All underwent conventional ultrasound,color Doppler,and CEUS(burst-replenishment technique).Renal artery resistive indices(RI)and CEUS parameters(cortical WiR,mean transit time[mTT],time to peak[TTP])were analyzed.Pearson correlation,multivariate logistic regression,and ROC analysis were performed.Results Compared to the DM group,the early DN group had significantly higher RI in the main renal artery(P<0.05).Both early and clinical DN groups had significantly higher RI in segmental and interlobar arteries(P<0.05).UACR correlated positively with DM duration,cortical thickness,segmental/interlobar RI,cortical mTT,and medullary TTP(P<0.05),and negatively with eGFR,renal/segmental artery diastolic velocity(Vd),cortical WiR,and medullary WiR/half WiR(P<0.05).eGFR correlated positively with renal/segmental/interlobar Vd and cortical half WiR/WiR(P<0.05),and negatively with DM duration,renal/segmental/interlobar RI,cortical TTP/mTT(P<0.05).Multivariate analysis identified longer DM duration[(O^R)=1.258(95%CI:1.088,1.454)]and lower cortical WiR[(O^R)=0.653(95%CI:0.434,0.982)]as independent risk factors for DN.ROC analysis showed AUCs for DM duration,cortical WiR,and their combination in diagnosing DN were 0.878(95%CI:0.788,0.967),0.737(95%CI:0.608,0.866),and 0.904(95%CI:0.827,0.982),with 84.2%(95%CI:0.624,0.945),73.7%(95%CI:0.512,0.882),83.3%(95%CI:0.608,0.942)in sensitivity and 76.7%(95%CI:0.623,0.869),71.4%(95%CI:0.564,0.828),86.1%(95%CI:0.727,0.934)in specificity,respectively.Conclusion CEUS reveals increasing vascular resistance and decreasing renal perfusion WiR with DN progression.Combining DM duration and cortical WiR provides high diagnostic value for DN.关键词
糖尿病肾病/超声造影/血流灌注/上升斜率/诊断/糖尿病病程Key words
diabetic nephropathy/contrast-enhanced ultrasonography/blood perfusion/wash-in rate/diagnosis/diabetes duration分类
医药卫生引用本文复制引用
安艳红,于泽兴,肖永华,陈宇,薛惠中,杨依萌,陈泉屹,王哲,石雪,沙培林..超声造影技术评估糖尿病肾病肾脏血流灌注的应用价值[J].中国现代医学杂志,2025,35(15):7-15,9.基金项目
首都卫生发展科研专项项目(No:首发2024-2-2032) （No:首发2024-2-2032）
