The Application Value Of Shear Wave Elastography In The Diagnosis Of Diabetic Kidney Disease

Objective: To explore its application value in the diagnosis of diabetic kidney disease(DKD),shear wave elastography(SWE)was applied to quantitatively detect the renal tissue elasticity of normal people and patients with different stages of diabetic kidney disease.Methods: 65 diabetic kidney disease patients diagnosed by renal biopsy in the second Affiliated Hospital of Hebei Medical University from December 2018 to December 2019 were selected as the study objects.According to the urinary albumin / creatinine(ACR),the research object was divided into three groups corresponding to DKD Ⅱ-Ⅳ,group Ⅰ: normal albuminuria group(ACR<30mg/g),group Ⅱ: Microalbuminuria group(30mg/g<ACR< 300mg/g),group Ⅲ: massive albuminuria group(ACR>300mg/g).During the same period,50 healthy volunteers who received physical examination in our hospital were selected as the normal control group.The renal length,parenchyma thickness and the Young modulus(YM)values of cortex,medulla and sinusoid of right renal inferior pole were measured by Supersonic Aixplorer type color doppler ultrasound.To compare the YM value of right kidney between normal control group and diabetic kidney disease group,to quantitatively analyze the YM value of right renal cortex,medulla and renal sinus in different stages of diabetic kidney disease,to analyze the correlation between YM of renal substance and ACR in diabetic kidney disease,and to explore the application value of SWE technology in the diagnosis of diabetic kidney disease.Results:1.There was no significant difference in the sampling depth of right kidney between the control group and diabetic kidney disease group(P>0.05).The length and thickness of right kidney in DKD group were smaller Ⅲthan those in the control group and DKD Ⅰ,Ⅱgroup,the difference was statist-ically significant(P < 0.05).2.The results of YM values of renal tissues in each test group showed that renal cortex> renal medulla> renal sinus;the YM values of renal cortex and renal medulla in the diabetic kidney disease group were significantly different from the control group(P <0.05).3.The YM of renal cortex in diabetic kidney disease group was higher than that in the control group,the difference was statistically significant(P < 0.05),and the YM of renal cortex gradually increased with the aggravation of DKD stage;There was no significant difference in YM of renal medulla between the control group and DKD I group(P > 0.05),compared with the control group and DKD I group,the YM value of renal medulla in DKD Ⅱgroup and III group was significantly different(P < 0.05);There was no significant difference in the YM of the renal sinus between the control group and each group of diabetic kidney disease(P>0.05).4.In diabetic kidney disease group,YM value of renal cortex and medulla was positively correlated with ACR(r=0.542,r=0.461).5.The area under the curve,diagnostic boundary value,sensitivity and specificity of the control group and diabetic kidney disease group were 0.852,12.67 kpa,76.9% and 84.0%.The area under the curve,diagnostic threshold,sensitivity and specificity between the control group and DKD group were Ⅰ0.733,12.67 kpa,54.2% and 84.0% The area under the curve,diagnostic boundary value,sensitivity and specificity of differential diagnosis between DKD group and DKD group were 0.664Ⅰ Ⅱ,.85 kpa,90.5% and 50.0%;the area under the curve,diagnostic boundary value,sensitivity and specificity of differential diagnosis between DKD group and DKD group were 0.732Ⅱ Ⅲ,16.37 kpa,60.0% and 85.7%.Conclusions:1.SWE technology can quantitatively reflect the elasticity information of kidney tissue in normal people and patients with different stages of DKD.The YM value is shown as renal cortex > renal medulla > renal sinus.2.With the increase of DKD stage,Young’s modulus of renal cortex and medulla gradually increased.3.The YM value of renal cortex and medulla measured by SWE was positively correlated with ACR,and the correlation was good.4.SWE is simple,noninvasive and economical,which can quantitatively evaluate the degree of chronic renal damage.It provides a new reference for clinical assessment of renal damage and differentiation of different stages of DKD,and helps to better monitor the progress of DKD.