Department of Endocrinology, Jiangsu Provincial Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
The First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing, China.
Front Endocrinol (Lausanne). 2023 Jul 7;14:1226830. doi: 10.3389/fendo.2023.1226830. eCollection 2023.
The diversity of clinical trajectories in diabetic kidney disease (DKD) has made blood and biochemical urine markers less precise, while renal puncture, the gold standard, is almost impossible in the assessment of diabetic kidney disease, and the value of functional magnetic resonance imaging in the evaluation of diabetic pathological alterations is increasingly recognized.
The literature on functional magnetic resonance imaging (fMRI) for the assessment of renal alterations in diabetic kidney disease was searched in PubMed, Web of Science, Cochrane Library, and Embase databases. The search time limit is from database creation to March 10, 2023. RevMan was used to perform a meta-analysis of the main parameters of fMRIs extracted from DKD patients and healthy volunteers (HV).
24 publications (1550 subjects) were included in this study, using five functional MRIs with seven different parameters. The renal blood flow (RBF) values on Arterial spin labeling magnetic resonance imaging (ASL-MRI) was significantly lower in the DKD group than in the HV group. The [WMD=-99.03, 95% CI (-135.8,-62.27), <0.00001]; Diffusion tensor imaging magnetic resonance imaging (DTI-MRI) showed that the fractional anisotropy (FA) values in the DKD group were significantly lower than that in HV group [WMD=-0.02, 95%CI (-0.03,-0.01), <0.0001]. And there were no statistically significant differences in the relevant parameters in Blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI) or Intro-voxel incoherent movement magnetic resonance imaging (IVIM-DWI).
ASL and DWI can identify the differences between DKD and HV. DTI has a significant advantage in assessing renal cortical changes; IVIM has some value in determining early diabetic kidney disease from the cortex or medulla. We recommend combining multiple fMRI parameters to assess structural or functional changes in the kidney to make the assessment more comprehensive. We did not observe a significant risk of bias in the present study.
https://www.crd.york.ac.uk, identifier CRD42023409249.
糖尿病肾病（DKD）的临床轨迹多样性使得血液和生化尿液标志物的准确性降低，而肾穿刺作为金标准，在评估糖尿病肾病时几乎不可能进行，功能磁共振成像在评估糖尿病病理改变方面的价值越来越受到认可。
在 PubMed、Web of Science、Cochrane Library 和 Embase 数据库中检索了关于功能磁共振成像（fMRI）评估糖尿病肾病肾改变的文献。检索时间限制为从数据库创建到 2023 年 3 月 10 日。使用 RevMan 对从 DKD 患者和健康志愿者（HV）中提取的主要 fMRI 参数进行了荟萃分析。
本研究纳入了 24 篇文献（1550 例患者），使用了 5 种功能 MRI 和 7 种不同的参数。动脉自旋标记磁共振成像（ASL-MRI）上的肾血流（RBF）值在 DKD 组明显低于 HV 组。[WMD=-99.03，95%CI（-135.8，-62.27），<0.00001]；扩散张量成像磁共振成像（DTI-MRI）显示 DKD 组的分数各向异性（FA）值明显低于 HV 组[WMD=-0.02，95%CI（-0.03，-0.01），<0.0001]。在血氧水平依赖磁共振成像（BOLD-MRI）或体素内不相干运动磁共振成像（IVIM-DWI）中，相关参数没有统计学差异。
ASL 和 DWI 可以识别 DKD 和 HV 之间的差异。DTI 在评估肾皮质变化方面具有显著优势；IVIM 在从皮质或髓质确定早期糖尿病肾病方面具有一定价值。我们建议结合多个 fMRI 参数来评估肾脏的结构或功能变化，以使评估更加全面。我们在本研究中没有观察到显著的偏倚风险。
https://www.crd.york.ac.uk，注册号 CRD42023409249。
