The Study On The Kidney And Liver In The Patients With Early Diabetic Nephropathy Using Integrated Backscatter Ultrasonography

The morbidity and mortality of diabetes mellitus (DM) isincreasing year by year in China at present, and DM onset age alsobecomes young. DM has become one of the diseases that increasemost quickly. According to world health organization (WHO) andinternational diabetes mellitus statistics, China has 50,000,000diabetic patients, and the morbidity of DM will achieve to more than10% in the coming ten years. DM and its complications is the majordisease that causing death and mutilation. Diabetic nephropathy (DN)is one of the major complications, due to DN onset delitescent, onceit has developed into clinical DN, the course of disease is irreversible,and it will develop into chronic renal failure in the end. DN hasgrown into the secondary primary disease of hematodialysis.Therefore, it's very important to diagnose early diabetic nephropathy(EDN), prevent and delay it occurrence or development. As DN is chronic, diffuse and progressive disease, thesensitivity and specificity that gray scale ultrasonography diagnosingEDN is fairly low, which can only observe renal size and shape, butcan't respond the early change of the tissue. Ultrasonic tissuecharacterization (UTC) is the foundation and clinical applicationstudy to approach the relationship between tissue acousticcharacteristic and ultrasonic appearance. It emphasizes therelationship between acoustic, texture parameters and tissuecondition in proper organism. To search an effective method toseparate parameter that can reflect the tissue state from theultrasound signals, and make it as the evidence to distinguishdifference tissues and identify disease quality, which is an importantstudy direction now. Among it the technology of backscatter canprovide very useful information of tissue condition. As supersonicwave spread in media, run into limiting surface which acousticimpedance difference of two media exceed 1%, and the diameter ofthe limiting surface less than wave length far away, it happen toscatter, the scatter towards the probe can be received by theprobe ,which is called backscatter. Integrated power spectrum ofreceived all the scatter signal is integrated backscatter (IBS). IBSisn't affected by compress or post processing of the ultrasoundsystem, and the image information comes from backscatter of tissue,so in abstracto it can reflect textural fine structure very well, thusreflect tissue character.Due to glucose and fat metabolism disorder, total lipids in liverincrease, the incidence of diabetes lead to adiposis hepatica is21%-78%. Liver biopsy is the golden marker to diagnose and judgeprognosis to adiposis hepatica, however, this traumatic check can'tbe used repeatedly to monitor therapeutic effect. Sonography is theprimary method to diagnose adiposis hepatica conveniently, but grayscale ultrasonography just depend macroscopic observation andempirical judgment, without quantitation standard, which lack ofobjectivity and accuratissime. This study analyzes the degree of thefatty liver using the IBS technology, and does quantitativeassessment to the fatty liver caused by diabetes more objectively.This study analyzes 60 DM patients and 30 healthy adults'cortex of kidney, medulla, renal sinus and near, middle, far field ofliver through IBS technology using American HP 5500ultrasonoscope, and observe size and shape of renal and liver by grayscale ultrasonography, approaching IBS technology to find the tissuestructure change of the kidney and liver in early diabeticnephropathy.The result, for all groups, IBS of renal sinus is highest, cortex issecondary, and medulla is lowest, the three different significantly(P<0.05), which is defined by internal structure of the kidney native,indicating that IBS could respond tissue character very well.Predecessor survey renal parenchyma IBS assess human renal, whilethis result show that there's significant difference between cortexand medulla, for this reason, assess cortex and medulla acousticdensity separately more scientific and fit the renal internal structure.Standardized IBS of cortex and medulla, control 0.05). Liver texture standardization IBS of diffuseadiposis hepatica patient with diabetes,near,middle,far fielddecrease progressively. The difference from near field to far field issignificant (p<0.05). For all groups, the ratio of far field/near field(attenuation rate) different significantly compared with control(p<0.05). The technology of IBS may reflect the fine structurechange conveniently, accurate quantitive, without wound. It's a moreobjective method to diagnose or monitor the disease quickly andsimply.The number of patients with cholesterol and triglycerideincrease is more than control, in which the patient ratio oftriglyceride increase is higher obviously. The level of cholesterol andtriglyceride is positive correlative with urine microalbumin (r=0.444,r=0.503,respectively, p<0.05). Therefore, hyperlipemia relate to DNintimately.Liver and kidney are the most important metabolism organ, ascomplicating EDN, their acoustic density different significantly fromhealthy adults', which develop regularly as the disease progress. IBStechnology conduces to assess the degree damage of kidney and liverin EDN patients, which develop the application of IBS technology inclinic.