| Objective The purpose of this study was to use contrast-enhanced ultrasound(C EUS) quantitative analysis technology and virtual touch quantification(VTQ) technical inspection the renal blood perfusion and renal tissue elasticity of control group and patients with type 2 diabetic nephropathy. To do statistical analysis of related parameters, and to do one-way ANOVA and Multivariate Logistic regression with urinary albumin excretion rate(UAER), in order to explor the early noninvasive imaging indicators diabetic kidney disease(DKD), to provide more for the early diagnosis and treatment of clinical.Methods According to WHO standards of diagnosis of diabetes mellitus(1999), tangshan gongren hospital of Endocrinology selected 90 cases of T2 DM patients from December 2013 to December 2014, including 47 males and 43 females, the age range of 26 to 68 years, mean age 52.03 ± 11.08 years. And select the same period of 30 cases of control group(15 males and 15 females, age range 30 to 65 years, mean age 51.37 ±9.59 years). According to Mogensen standards of diagnosis, Diabetes patients were divided into there groups:Normal albuminuria group(group A), early nephropathy group(group B) and clinical kidney disease group(group C). Using Philips i U 22 and Siemens S2000 color doppler ultrasonic diagnostic instrument respectively C EUS and VTQ inspections on all the research object, to measure the quantitative parameters which reflected the Renal perfusion,Including curve rise time(RT), the area under the curve(AUC), derived peak intensity(DPI), the curve of time to peak(TTP) and time from peak to one half, and also measure the lateral shear wave velocity(Vs) which reaction the renal tissue elastic resilience. General information of all subjects on(height, weight, blood pressure, etc.) and related laboratory tests, including: UAER, serum total cholesterol(TC), high-density lipoprotein cholesterol(HDL-C), triglyceride(TG) and low density lipoprotein cholesterol(LDL-C), glycosylated hemoglobin(Hb A1c) and fasting plasma glucose(FBG). All the data was analyzed by statistical software SPSS 19.0. Using K-S test of goodness to inspect whether the information accord with normal distribution. The non normal distribution measurement data was analyzed using the Friedman test. The normal distribution of the measure information are expressed as mean± standard deviation( x ±s), multiple sets of data were compared using one-way ANOVA. By Levene for homogeneity of variance test, if test of equality of mea ns, comparison between groups by LSD test, or by Dunnett’s T3 test. Counting information was expressed as percent, comparing use chi-squared 2 test. Spearman correlation between the indicators, analyze and calculate the correlation coefficient. Multivariate Logistic regression was used to analysis of risk factors for UAER. Using ROC curve, combined with the specificity and sensitivity of getting maximum cut-off value, estimation of related parameters in assessing early DKD boundary value. Test standard: P<0.05 statistical significant.Results 1 Comparison of gender, age, TG, TC, HDL-C, LDL-C, SBP, DBP, BMI of patients between 3 groups DM patients and the control group were no statistically significant(P>0.05), but there was significant difference in family history of diabetes mellitus(P<0.01). Comparison of T2 DM duration, FBG and Hb Alc of patients between 3 groups DM patients,group C were higher than those in group A, group B, the differences were statistically significant(P<0.01), but the differences between group A and group B had no statistical significance(P>0.05). 2 Real time CEUS displayed clear imaging of kidney perfusion. The differences between left and right kidney C EUS related parameters within DM 3 groups and the control group had no statistical significance(P>0.05). The control group, group A, group B and group C comparison, the DPI were reduced, the differences were statistically significant(P<0.01). Compared with the control group, the AUC of the patients in group A and group B were increased, and the patients in group C were decreased, the differences were statistically significant(P<0.01). The TTP, RT of the patients in group B and group C were longer than those of the control group(P<0.05), but there were no significant differences between group A and the control patients(P>0.05). Compared with the control group, the time from peak to one half of the patients in group A and group B were no statistically significant(P>0.05), but there were significant differences between group C and the control patients(P<0.01). 3 In all cases,the Vs was the highest in renal parenchyma(P<0.01), And mean Vs measurements differences between the middle pole of right and left renal parenchyma and renal sinus were statistically not significant(P>0.05). In group C the Vs in renal parenchyma was lower than the control group(P=0.02<0.05), but there had no significant differences between the two groups in the renal sinus(P>0.05). In group A and group B the Vs in renal parenchyma and renal sinus had no significant differences to the control group. Comparison between 3groups DM patients, in group A and group B the Vs in renal parenchyma were higher than those in group C and the differences were statistically significant(P<0.05), but the differences between group A and group B had no statistical significance(P>0.05). And There had no significant differences between the 3 groups DM patients in the renal sinus(P>0.05). 4 By Spearman correlation analyzed, UAER has positive correlation with RT, TTP and time from peak to one half(P<0.01), and had negative correlation with DPI, the Vs in renal parenchyma(P<0.05). 5 In a merger of the UAER as the independe nt variable, line diabetics multivariate Logistic regression analysis showed that UAER had positive correlation with FBG, duration, Hb A1 C, family history of diabetes, Non-vegetarian meals and RT, DPI, namely a increased risk of early DK D. According to the ROC curve, When the RT, DPI boundary value in 15.94 s and 13.53 d B, its sensitivity and specificity in evaluating early DKD respectively was 81.8%, 68.2% and 80.4%, 87.0%, and there is a good consistency between RT and DPI. When parallel RT with DPI, sensitivity and specificity respectively: 88.6%, 78.3%.Conclusions 1 The CEUS technical can analyze the changes of renal perfusion parameters, the RT, AUC, DPI and TTP had abnormal, which can be used in evaluating renal abnormality of the DKD patients in early period. 2 UAER has positive correlation with RT, TTP and time from peak to one half which reflected the renal perfusion, and has negative correlation with DPI. As the illness is aggravating, RT, TTP and time from peak to one half values are longer, DPI value is higher. The RT, DPI and TTP values to a certain extent can accurately determine the early DKD degree of kidney damage, and offers new reference for the early DKD diagnosis. 3 VTQ can quantitatively study the changes of tissue elastic compliance of DKD, area the renal parenchyma area > the renal sinus area, the Vs in renal parenchyma has negative correlation with renal damage degree, as the illness is aggravating, The Vs value is lower, providing a new noninvasive quantitative evaluation index for diagnosing these disease. |
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