糖尿病肾病的非侵入性诊断与监测：通过扩散峰度成像评估肾功能和纤维化

Non-Invasive Diagnosis and Monitoring of Diabetic Nephropathy: Assessment of Renal Function and Fibrosis by Diffusion Kurtosis Imaging.

作者信息

Yuan Jian-Lei, Hu Li-Ao, Wang Xin-Yu, Shi Zhao-Yu, Chen Ting, Huang Xin-Zhong, Wu Yu, Cai Qiu-Jie, Yang Zi-Xu, Chen Xin-Yi, Yuan Li, Zhang Yuan

机构信息

Department of Nephrology, Affiliated Hospital of Nantong University, Nantong, 226001, People's Republic of China.

Medical School of Nantong University, Nantong, 226001, People's Republic of China.

出版信息

Int J Gen Med. 2025 Jul 21;18:4011-4026. doi: 10.2147/IJGM.S517683. eCollection 2025.

DOI:10.2147/IJGM.S517683

PMID:40717819

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12297023/

Abstract

BACKGROUND

This monocentric, cross-sectional study explored the use of diffusion kurtosis imaging (DKI) as a non-invasive means to diagnose and monitor diabetic nephropathy (DN).

METHODS

Patients with diabetes mellitus (DM, n = 11), mild DN (N = 14), and severe DN (n = 29) were recruited. Eight DKI metrics (MK, MD, Da, Dr, Ka, Kr, FA, FAk) were determined from the imaging results, and their correlations with routine laboratory results were analyzed. The receiver operating characteristic (ROC) curves were plotted, and the diagnostic value of the DKI metrics was analyzed. In addition, renal biopsy was carried out for ten DN patients who had appropriate indications. Their interstitial fibrosis and tubular atrophy (IFTA) score and the fibrosis ratio of cortical area (F%) were analyzed in combination with the DKI metrics.

RESULTS

The progression of DN, reflected by the estimated glomerular filtration rate (eGFR), was accompanied by rising mean kurtosis (MK) and axial kurtosis (Ka) along with decreasing mean diffusivity (MD), axial diffusivity (Da), and radial diffusivity (Dr). Whereas MK was correlated negatively with hemoglobin (Hb) and eGFR and positively with neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CysC), and serum creatinine (Scr), MD, Da, and Dr were positively correlated with Hb and eGFR and negatively correlated with CysC and Scr. For the biopsied patients, MK was positively correlated with IFTA, and fractional anisotropy of kurtosis (FAk) was negatively correlated with F% and IFTA. Among the DKI indicators, MK had the highest AUC (0.922, 95% CI: 0.843-1.000).

CONCLUSION

The noninvasive monitoring of DN was feasible with DKI, and MK could indicate the renal function and fibrosis of DN patients. Changes in MK may also serve as a biomarker to assess treatment response (eg, microstructural improvement) after therapeutic interventions (eg, drug therapy for diabetic nephropathy, anti-fibrotic therapy).

摘要

背景

本单中心横断面研究探讨了使用扩散峰度成像（DKI）作为诊断和监测糖尿病肾病（DN）的非侵入性方法。

方法

招募了糖尿病（DM，n = 11）、轻度DN（N = 14）和重度DN（n = 29）患者。从成像结果中确定八个DKI指标（MK、MD、Da、Dr、Ka、Kr、FA、FAk），并分析它们与常规实验室结果的相关性。绘制受试者工作特征（ROC）曲线，并分析DKI指标的诊断价值。此外，对十名有适当指征的DN患者进行了肾活检。结合DKI指标分析了他们的间质纤维化和肾小管萎缩（IFTA）评分以及皮质区纤维化率（F%）。

结果

由估计肾小球滤过率（eGFR）反映的DN进展伴随着平均峰度（MK）和轴向峰度（Ka）升高，同时平均扩散率（MD）、轴向扩散率（Da）和径向扩散率（Dr）降低。而MK与血红蛋白（Hb）和eGFR呈负相关，与中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、胱抑素C（CysC）和血清肌酐（Scr）呈正相关，MD、Da和Dr与Hb和eGFR呈正相关，与CysC和Scr呈负相关。对于接受活检的患者，MK与IFTA呈正相关，峰度分数各向异性（FAk）与F%和IFTA呈负相关。在DKI指标中，MK的曲线下面积（AUC）最高（0.922，95%CI：0.843 - 1.000）。