彩色多普勒超声测量肾血流动力学参数对早期预测糖尿病肾病肾损害程度的诊断价值

摘要

目的：探讨彩色多普勒超声测量肾血流动力学参数对早期预测糖尿病肾病（DN）肾损害程度的诊断价值。方法选取我院2013年1月至2015年12月收治的150例糖尿病肾病患者作为研究对象，根据24 h尿蛋白定量的不同分为3组，即尿蛋白正常组36例、早期DN组52例和临床期DN组62例，同时选取50名健康成人作为对照组。分别检查各组彩色多普勒超声，比较各组肾脏大小及血流成像。结果临床期DN组的肾脏主肾动脉（MRA）、肾窦部段动脉（SRA）、肾椎体叶间动脉（IRA）各取样点的Vsmax 均明显低于对照组（P<0.05），早期DN组仅IRA这一取样点的Vsmax明显低于对照组（P<0.01），但随着肾损害程度的加重，各取样点的Vsmax均逐渐降低。 DN组中尿蛋白正常组、早期DN组以及临床期DN组3组的MRA、SRA、IRA各取样点的Vdmin均明显低于对照组（P<0.01）。 DN组中尿蛋白正常组、早期DN组以及临床期DN组3组的MRA、SRA、I－RA各取样点的RI均明显高于对照组（P<0.05）。临床期DN组肾脏体积明显小于其余3组（P<0.01）。结论彩色多普勒超声测量肾血流动力学参数可有效反映出糖尿病肾病肾脏损害程度，对糖尿病肾病的早期诊断具有重要价值。%Objective To explore the diagnostic value of Color Doppler ultrasound measurement of renal hemodynamic parameters for the degree of diabetic renal damage in patients with diabetic nephropathy (DN). Methods One hundred and fifty cases with diabetic nephropathy (DN) in our hospital from January 2013 to December 2015 were selected as the research objects. They were divided into three groups, which were normal group with urinary pro-tein of normal level(36 cases), early DN group (52 cases) and clinical stage DN group(62 cases) according to the 24h urine protein quantity. At the same time, 50 cases of healthy adults were chosen as the control group. Patients in each group were examined by color Doppler ultrasound and the renal size and blood flow imaging of patients in each group were compared. Results The Vsmax of the MRA, SRA and IRA at different sampling points in the clinical stage of group DN were significantly lower than those of the control group(P<0.05). In the early group DN, only the Vsmax at the sample point of IRA was significantly lower than that of the control group (P<0.01). But with the increase of the degree of renal damage, the Vsmax at different sampling points were gradually reduced. The Vdmin of SRA, MRA and IRA at different sampling points in the normal urinary protein group, early group DN and clinical stage group DN of group DN were significantly lower than those in control group(P<0.01). The RI of SRA, MRA and IRA at different sampling points in the normal urinary protein group, early group DN and clinical stage group DN of group DN were significantly higher than those in control group(P<0.05). The renal volume of group DN was significantly smaller than that in the other three groups (P<0.01). Conclusion Color Doppler ultrasound measurement of renal hemodynamic parameters can effectively show the degree of renal damage in patients with diabetic nephropathy and has important value in early diagnosis of diabetic nephropathy.