Preliminary Evaluation On Renal Cortial Blood Flow In Diabetic Patients With Dynamic Sonographic Tissue Perfusion Measurement

Research Background:The incidence of diabetes mellitus (particularly type 2) continuously raises in China in recent years, the DN(Diabetic Nephropathy) is the main capillaries complication for diabetes, and also the main reason of the last phase of diabetes mellitus. Therefore, it is of great importance in diagnosing, curing and prognostic assessment of renal disease in early days. This search applies Dynamic Sonographic Tissue Perfusion Measurement(DTPM) to analyze the parameters of renal cortex in each group of diabetic patients and control group,and discuss the clinical value of this technique on renal damage in early days of diabetes mellitus.Purpose:To apply DTPM to analyse renal cortical blood flow dynamics and explore the accurate and quantitative advantages of this technique on renal damage.Subjects and Methods:82 in and out-patients of Type 2 diabetics who were from September 2009 to October 2010. Divide them into different groups based on Glomerular Filtration Rate (GFR):GFR normal or increased group(Group I),GFR lightly-dropped group(Group II), GFR moderately-dropped group(Group III),GFR heavily-dropped group(Group IV).And 40 age-and sex-matched normal controls were enrolled.DTPM:Use GE Vivid7 ultrasound system to collect the videos of kidneys of diabetic patients and control group for 3 to 5 stable heartbeat period. Copy the videos with the format of DICOM to computers updated with PixeFlux for analysis. PixeFlux automatically analyzed the blood signals change with heart period in ROI and it figured outⅤmix,Ⅰmix and TRI. Meanwhile, it divides ROI equally into 10 sub-ROI from p010-ROI to p100-ROI and recorded the skewness of persusion intensity frequency distribution curve.Results:1. (1) There were significant diffencences between diabetic groupⅠand control group inⅠmix andⅤmix(P<0.05),but TRI and RI were not significantly different in the above two groups(P>0.05),whereas there was no statistical difference between diabetic groupⅡand control group inⅠmix,Ⅴmix TRI and RI (P>0.05),and compared to control group,Ⅰmix,Ⅴmix,TRI and RI were significantly different in diabetic groupⅢandⅣ(P>0.05).(2) There were significant diffencences between diabetic groupⅠandⅡinⅠmix andⅤmix(P<0.05), but TRI and RI were not significantly different in the above two groups(P>0.05), and compared to diabetic groupⅠ,Ⅰmix,Ⅴmix,TRI and RI were significantly different in diabetic groupⅢandⅣ(P<0.05).(3) There were statistical difference between diabetic groupⅢ,ⅣandⅡinⅠmix,Ⅴmix,TRI and RI (P＜0.05).(4) Compared to diabetic groupⅢ,Ⅰmix,Ⅴmix,TRI and RI were significantly different in diabetic group IV(P<0.05).2.Skewness of perfusion intensity distributions approximatively peaked in p050-ROI of diabetic group I and II,whereas skewness of perfusion intensity distributions tended to rise from p010-ROI to p100-ROI in diabetic groupⅢ,Ⅳand control group.3. The correlation between DTPM parameters and the course of disease:both Imix and Vmix have negative relation with their course of disease in all diabetic groups.Conclusion:1.DTPM can detect renal damage of type 2 diabetic patients before the increased levels of the serum creatinine,nitrogen and RI.2.The trend of skewness of diabetic group I prompts the early diabetic kidney damage appears in peripheral area.3. DTPM parameters and the course of disease have negative relation, reflect the parameters can impaired progression of diabetic peripheral vascular.