Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China.
Department of Nephrology, First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, Beijing Key Laboratory of Kidney Diseases, Beijing, China.
J Ultrasound Med. 2021 Jul;40(7):1361-1368. doi: 10.1002/jum.15516. Epub 2020 Oct 9.
To conduct a quantitative analysis of renal microvascular perfusion in diabetic patients with kidney injury using contrast-enhanced ultrasound (CEUS).
A total of 172 patients with type 2 diabetes mellitus and kidney injury were recruited from May 2017 to November 2019. After collection of clinical characteristics, a CEUS examination was performed after injection of the contrast agent SonoVue (Bracco SpA, Milan, Italy). Time-intensity curves and renal perfusion parameters were analyzed. Ultrasound-guided renal biopsy was performed. The patients were divided into a diabetic nephropathy (DN) group and a nondiabetic renal disease (NDRD) group according to renal pathologic results. The discrimination of perfusion parameters between the groups was analyzed statistically with SPSS version 19.0 software (IBM Corporation, Armonk, NY). Receiver operating characteristic curves were used to illustrate the diagnostic performance of indicators.
Ninety-eight patients, including 45 with DN (29 male; mean age ± SD, 57.76 ± 10.47 years) and 53 with NDRD (40 male; mean age, 48.7 ± 13.88 years) were included in this study. The peak enhancement (PE), wash-in the area under the curve (AUC), wash-in rate, wash-in perfusion index, wash-out AUC, wash-in and wash-out AUC, and wash-out rate were significantly different between the groups (P < .05). There were no differences in time-related parameters between the DN and NDRD groups (P > .05). The receiver operating characteristic curve analysis showed that the AUC for PE was 0.727, and PE lower than 7712.426 had diagnostic potential, with sensitivity of 81% and specificity of 40% in discriminating between NDRD and DN.
The quantification of CEUS parameters can discriminate DN in diabetic patients with kidney injury. The PE and AUC may be feasible parameters.
使用超声造影（CEUS）对合并肾损伤的糖尿病患者的肾脏微血管灌注进行定量分析。
本研究共纳入 2017 年 5 月至 2019 年 11 月期间 172 例 2 型糖尿病合并肾损伤患者，采集临床特征后，经肘静脉注射 SonoVue（Bracco SpA，米兰，意大利）造影剂后行 CEUS 检查，分析时间-强度曲线和肾脏灌注参数。行超声引导下肾活检，根据肾脏病理结果将患者分为糖尿病肾病（DN）组和非糖尿病肾病（NDRD）组，采用 SPSS 19.0 软件（IBM 公司，纽约州阿蒙克）对灌注参数在两组间的差异进行统计学分析。采用受试者工作特征曲线（ROC 曲线）说明各指标的诊断性能。
本研究共纳入 98 例患者，其中 45 例为 DN（男 29 例；平均年龄 57.76±10.47 岁），53 例为 NDRD（男 40 例；平均年龄 48.7±13.88 岁）。两组的峰值增强（PE）、曲线下面积（AUC）的上升斜率、上升灌注指数、上升 AUC、下降 AUC、上升和下降 AUC、下降斜率差异均有统计学意义（P<.05）。DN 组与 NDRD 组的时间相关参数差异无统计学意义（P>.05）。ROC 曲线分析显示，PE 的 AUC 为 0.727，PE 低于 7712.426 具有鉴别诊断 NDRD 和 DN 的潜力，其敏感度为 81%，特异度为 40%。
CEUS 参数的定量分析可用于鉴别合并肾损伤的糖尿病患者的糖尿病肾病，PE 和 AUC 可能是可行的参数。
