首页|超声微血流成像联合血清炎症因子对糖尿病肾病的诊断价值

超声微血流成像联合血清炎症因子对糖尿病肾病的诊断价值

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目的 探究超声微血流成像(MFI)联合血清炎症因子对糖尿病肾病(diabetic kidney disease,DKD)早期诊断的价值。方法 选取2022年6月1日-2023年6月30日青岛大学附属医院收治的92例DKD患者为DKD组,另选取同期本院收治的64例2型糖尿病(T2DM)患者为T2DM组,收集两组患者的临床相关指标、超声血流参数以及血清炎症因子水平。超声血流参数包括MFI值、左肾叶间动脉阻力指数(RI1)、右肾叶间动脉阻力指数(RI2)、左肾叶间动脉峰值流速(PSV1)、右肾叶间动脉峰值流速(PSV2)。采用Spearman方法分析MFI值与临床指标、血清炎症因子的相关性,二元logistic回归中向前有条件的方法分析DKD的影响因素,以受试者工作特征(ROC)曲线分析MFI值和血清炎症因子对DKD的预测价值。结果 T2DM组RI1及血液中C-反应蛋白(CRP)、IL-6、IL-18 水平低于 DKD 组(Z=-6。73~-3。20,P<0。05),而 MFI 值、PSV2水平高于 DKD 组(Z=-9。53、-2。67,P<0。05)。MFI值与血红蛋白(HB)水平、估算肾小球滤过率(eGFR)呈正相关,与血肌酐(Scr)、尿微量白蛋白肌酐比值(UACR)呈负相关;血清IL-6与Scr、UACR呈正相关,与HB、eGFR呈负相关。二元logistic回归分析显示,MFI值(OR=0。596,95%CI=0。473~0。751)、血清 IL-6(OR=2。184,95%CI=1。243~3。839)均对 DKD 的诊断具有提示作用(P<0。05)。MFI值、血清IL-6单独诊断T2DM患者发生DKD的曲线下面积(AUC)分别为0。949(95%CI=0。909~0。989)、0。830(95%CI=0。767~0。892),两者联合诊断的 AUC 为 0。970(95%CI=0。942~0。999)。结论 MFI值联合血清IL-6水平检测可提升DKD早期临床诊断率,可为DKD的监测和预防提供借鉴。
Value of ultrasound micro-flow imaging combined with serum inflammatory factors in the diagnosis of diabetic kidney disease
Objective To investigate the value of ultrasound micro-flow imaging(MFI)combined with serum inflamma-tory factors in the early diagnosis of diabetic kidney disease(DKD).Methods A total of 92 patients with DKD who were admit-ted to The Affiliated Hospital of Qingdao University from June 1,2022 to June 30,2023 were enrolled as DKD group,and 64 pa-tients with type 2 diabetes mellitus(T2DM)who were admitted to our hospital during the same period of time were enrolled as T2DM group.Related data were collected for the two groups,including clinical indicators,ultrasound blood flow parameters,and serum inflammatory factors.Ultrasound blood flow parameters included MFI-value,left renal interlobar artery resistance index(RI1),right renal interlobar artery resistance index(RI2),left renal interlobar arterial peak velocity(PSV1),and right renal in-terlobar arterial peak velocity(PSV2).The Spearman method was used to investigate the correlation of MFI-value with clinical in-dicators and serum inflammatory factors;the forward conditional approach in binary logistic regression was used to analyze the im-pact of DKD;the receiver operating characteristic(ROC)curve was used to analyze the value of MFI-value and serum inflammato-ry factors in predicting DKD.Results Compared with the DKD group,the T2DM group had significantly lower RI1 and serum levels of C-reactive protein,interleukin-6(IL-6),and interleukin-18(Z=-6.73--3.20,P<0.05)and significantly higher levels of MFI-value and PSV2(Z=-9.53,-2.67,P<0.05).MFI-value was positively correlated with hemoglobin(HB)and estimated glomerular filtration rate(eGFR)and was negatively correlated with serum creatinine(Scr)and urinary albumin-to-creatinine ratio(UACR);serum IL-6 was positively correlated with Scr and UACR and was negatively correlated with HB and eGFR.The binary logistic regression analysis showed that MFI-value(OR=0.596,95%CI=0.473-0.751,P<0.05)and serum IL-6(OR=2.184,95%CI=1.243-3.839,P<0.05)showed a certain effect in the diagnosis of DKD.MFI-value and serum IL-6 alone had an area un-der the ROC curve(AUC)of 0.949(95%CI=0.909-0.989)and 0.830(95%CI=0.767-0.892),respectively,in the diagnosis of DKD in T2DM patients,and the combination of MFI-value and serum IL-6 had an AUC of 0.970(95%CI=0.942-0.999).Con-clusion MFI-value combined with the serum level of IL-6 can im-prove the early clinical diagnostic rate of DKD,which may provide a reference for the monitoring and prevention of DKD.

Diabetic nephropathiesUltrasonographyHemodynamicsInterleukin-16Interleukin-18Early diagnosis

张栋杰、郑曙光、张行健、刘丛聪、汤贞林、马瑞霞

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青岛大学附属医院肾病科,山东 青岛 266003

青岛大学附属医院超声科,山东 青岛 266003

糖尿病肾病 超声检查 血流动力学 白细胞介素6 白细胞介素18 早期诊断

山东省自然科学基金项目泰山学者工程专项项目青岛市医药卫生科研计划项目

ZR2022MH161tstp202306652021-WJZD189

2024

精准医学杂志
青岛大学

精准医学杂志

ISSN:2096-529X
年,卷(期):2024.39(4)
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