目的 探究肾超声检查联合血流动力学指标对早期糖尿病肾病(DN)的诊断价值.方法 回顾性分析2021年2月至2023年11月本院收治的78例DN患者的临床资料,依据不同24 h尿蛋白定量(24 h U-pro)将患者分为DN临床期组(48例,24 h U-pro＞0.5 g)和DN早期组(30例,24 h U-pro为0.15～0.50 g);另选取肾功能正常的30例糖尿病(DM)患者设为DM组,比较三组患者的超声肾脏扫描以及血流动力学指标.结果 DN临床期组患者的肾脏体积小于DN早期组与DM组,DN早期组患者的肾脏体积小于DM组,差异均有统计学意义(均P＜0.05).DN临床期组患者的肾主动脉Vsmax、Vdmin均低于DN早期组与DM组,RI高于DN早期组与DM组,DN早期组患者的肾主动脉Vsmax、Vdmin低于DM组,RI高于DM组,差异均有统计学意义(均P＜0.05).DN临床期组患者的肾窦部动脉Vsmax、Vdmin低于DN早期组与DM组,RI高于DN早期组与DM组,DN早期组患者的肾窦部动脉Vsmax、Vdmin均低于DM组,RI高于DM组,差异均有统计学意义(均P＜0.05).DN临床期组患者的肾叶间动脉Vsmax、Vdmin低于DN早期组与DM组,RI高于DN早期组与DM组,DN早期组患者的肾叶间动脉Vsmax、Vdmin低于DM组,RI高于DM组,差异均有统计学意义(均P＜0.05).结论 超声检查在评定不同阶段DN的肾脏结构和血液流动特性方面具有高度的精确性.此技术能够详细揭示DN患者肾脏损害的程度.在诊断早期DN时,血液流动的测量指标显示出极大的临床应用潜力.
Diagnostic value of renal ultrasonography combined with hemodynamic indexes in early diabetic nephropathy
Objective To explore the diagnostic value of renal ultrasonography combined with hemodynamic indexes in early diabetic nephropathy(DN).Methods The clinical data of 78 patients with DN admitted to our hospital from February 2021 to November 2023 were retrospectively analyzed.According to different 24 h urinary protein levels(24 h U-pro),the patients were divided into clinical DN group(48 cases,24 h U-pro＞0.5 g)and early DN group(30 cases,24 h U-pro was 0.15-0.5 g),and and 30 DM patients with normal renal function were selected as DM group.The ultra-sound renal scan and hemodynamic parameters of the three groups were compared.Results The kid-ney volume of patients in the DN clinical stage group was significantly lower than that in the early DN group and the DM group,and the kidney volume of patients in the early DN group was significantly lower than that in the DM group(all P＜0.05).Vsmax and Vdmin of renal aorta in the DN clinical stage group were lower than those in the early DN group and DM group,RI was higher than those in the early DN group and DM group,Vsmax and Vdmin of renal aorta in the early DN group were lower than those in the DM group,RI was higher than those in the DM group,and the differences were statistically signifi-cant(all P＜0.05).The renal sinus artery Vsmax and Vdmin of patients in the DN clinical stage group were lower than those in the early DN group and DM group,RI was higher than those in the early DN group and DM group,the renal sinus artery Vsmax and Vdmin of patients in the early DN group were low-er than those in the DM group,and RI was higher than those in the DM group,with statistical signifi-cance(all P＜0.05).The renal interlobar artery Vsmax and Vdmin of patients in the DN clinical stage group were lower than those in the early DN group and DM group,RI was higher than those in the early DN group and DM group,the renal interlobar artery Vsmax and Vdmin of patients in the early DN group were lower than those in the DM group,and RI was higher than those in the DM group,with statistical significance(all P＜0.05).Conclusions Ultrasonography is highly accurate in evaluating renal struc-ture and blood flow characteristics in different stages of DN.This technique can reveal the extent of kid-ney damage in DN patients in detail.The measurement of blood flow shows great potential for clinical ap-plication in the diagnosis of early diabetic nephropathy.
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