| Objective:The purpose of this article is to evaluate the clinical value of ultrasound in the morphological and hemodynamic changes of type 2 diabetic nephropathy(T2DM)in different stages by detecting the renal volume,blood perfusion and hemodynamic parameters of patients with different urinary albumin stages.Methods:We collected a total of 77 cases patients who were diagnosed by clinical endocrinology with type 2 diabetes mellitus from the First Affiliated Hospital of Guangxi Medical University in October 2017 to October 2018,all of the entrants are in line with the international general WHO diagnostic criteria(1999),aged 40 to 65 years old,excluding other diseases can lead to kidney damage.The patients were divided into three groups according to the urinary albumin creatinine ratio(UACR):there were totally 31 cases in group ?(in the stage of normal albuminuria,UACR<3.0mg/mmol),including 17 males and 14 females,with an average age of(56.94±7.77)years old.There were 33 cases in group ?(in the stage of microal buminuria,3.0<UACR<30.0 mg/mmol),included 11 males and 19 females,with an average age of(57.53±7.05)years old.There were 16 cases in group ?(in the stage of massive albuminuria or dominant albuminuria,UACR>30.0mg/mmol),included 12 males and 4 females,with an average age of(56.13±7.88)years old.There were also 35 healthy subjects of the same age were randomly selected as the normal control group,including 19 males and 16 females,with an average age of(56.29±5.74)years old.First measure the length(L),width(W),and thickness(T)of the kidney by two-dimensional gray-scale ultrasound,place it into the ellipsoid formula V=?/6×L×W×T(cm),to calculate the kidney volume.We use the body surface area(S)corrected the volume which recorded as V/S.Then observe the bilateral renal perfusion status by color Doppler ultrasound,measured left and right sides of the main renal artery(MRA),segmental renal artery(SRA),interlobar renal artery(IRA),maximum the lumen diameter(D),machine preset automatic trace and calculate the all levels of intravascular peak systolic velocity(PSV),end diastolic velocity(EDV),resistance index(RI),pulse index(PI),arterial blood flow(VF),All the above reference values were taken as the mean value of both kidneys.Finally,the ratio of blood flow of each inferior artery to the superior artery was calculated,recorded as IRA/MRA-VF,IRA/SRA-VF,and SRA/MRA-VF.At the same time,cystatin C(Cys-C),endogenous creatinine clearance(Ccr),creatinine(CREA)and UREA were recorded in all subjects SPSS 17.0 statistical software was used for data processing,and the correlation between the ultrasonic measured values and the above renal function indicators was analyzed.Results:Compared with the control group,T in group ?,? and ? was greater than that in the control group,and the difference was statistically significant(P<0.05).Compared among diabetes groups,T of group ? was significantly different from that of group ? and ?(P<0.05),T of group ? was significantly different from that of group ?(P<0.05)V in group ? and ? was greater than that in the control group,and the difference was statistically significant(P<0.05).Compared V of group ? with group ? and compared group ? with group ? separately among the diabetes groups,and the difference was statistically significant(P<0.05)V/S of group ?,? and ? was significantly higher than that of the control group(P<0 05).Compared V/S in diabetes groups,there were statistically significant differences between the group ? with group ? or group ?(P<0.05)Compared V/S in group ? with group ?,the difference was statistically significant(P<0.05)MRA-PSV and SRA-PSV of group ? and control group were compared,and the difference was statistically significant(P<0.05).SRA-PSV of group ?was significantly different from that of control group(P<0.05).IRA-PSV of group ? was compared with that of control group,and the difference was statistically significant(P<0.05).Compared among the diabetes group,the PSV of renal internal arteries in groups ?,? and ? showed a decreasing trend IRA-PSV of group ? was significantly different from that of group ? and ?(P<0.05)SRA-EDV of group ? was significantly different from that of control group(P<0.05).MRA-EDV and IRA-EDV of group ? were compared with the control group,and the differences were statistically significant(P<0.05).Comparison of MRA-EDV,SRA-EDV and IRA-EDV between group ? and control group showed statistically significant differences(P<0.05).Compared with the diabetes group,the EDV of the renal internal arteries in groups ?,? and ?showed a decreasing trend.MRA-EDV,SRA-EDV and IRA-EDV of group ?were significantly different from those of group ? and ?(P<0.05)In the control group,RI and PI of the internal renal arteries in groups ?,?and ? increased.RI and PI in groups ? and ? were significantly different from those in the control group(P<0.05).Comparison of RI and PI among the diabetes groups showed statistically significant differences between group ? and group ?(P<0.05),and between group ? with group ? or group ?(P<0.05)SRA-VF of group ? was higher than that of group ?(P<0.05).IRA-VF of group ? was lower than that of control group(P<0.05).Compared among the diabetes group,the renal internal artery VF of the ?,? and ? groups showed a decreasing trend.SRA-VF and IRA-VF of group ? were compared with those of group ? and ?,and the differences were statistically significant(P<0.05)IRA/MRA-VF and IRA/SRA-VF of group ? were compared with those of the control group or group ? or group ?,and the differences were statistically significant(P<0.05).There was no significant difference between the other groups(P>0.05)MRA-RI,MRI-PI,IRA-RI and IRA-PI were positively correlated with Cys-C and CREA in T2DM patients(P<0.05),and negatively correlated with Ccr(P<0.05).SRA-RI and SRA-PI were positively correlated with Cys-C,CREA and UREA(P<0.05)and negatively correlated with Ccr(P<0.05)Conclusions:1.Two-dimensional gray-scale ultrasound showed that the volume of DKD kidney had increased during the normal albuminuria stage,which provided a basis for the early diagnosis of DKD kidney injury.2.Color Doppler ultrasound can visually display the changes of renal blood perfusion in DKD at different stages,which is helpful to judge the presence and extent of DKD.3.The ratio of IRA/MRA and IRA/SRA blood flow measured by spectral Doppler ultrasonography is a significant parameter to reflect the damage of peripheral vascular bed in the middle and late stages of DKD.4.The RI and PI of renal artery in patients with T2DM are closely related to the laboratory indexes of renal function.5.Ultrasound technology provides diagnostic basis for clinical evaluation of renal function changes,and has important significance for monitoring the progress of DKD,and has high clinical application value. |
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