【摘要】 目的应用彩色多普勒超声技术评价糖尿病肾病(DN)患者肾内动脉阻力指数(RI)与腹主动脉内-中膜厚度(AA-IMT)的相关性。方法以35名健康自愿者为对照组(A组),根据肾小球滤过率(GFR)将93例2型DN患者分为3组,其中B组33例GFR≥90 ml/(min·1.73 m~2),C组(31例)60 ml/(min·1.73 m~2)≤GFR<90 ml/(min·1.73 m~2),D组29例GFR<60 ml/(min·1.73 m~2),应用彩色多普勒超声技术获得肾内动脉RI和腹主动脉AA-IMT。结果 B、C、D组RI及AA-IMT均高于A组(P均<0.05),C、D组均高于B组(P均<0.05),D组高于C组(P<0.05)。RI与AA-IMT(r=0.90,P<0.01)、糖化血红蛋白(r=0.58,P<0.01)、空腹血糖(r=0.66,P<0.01)、总胆固醇(r=0.42,P<0.01)、低密度脂蛋白(r=0.03,P<0.01)、肌酐(r=0.64,P<0.01)及尿酸(r=0.54,P<0.01)均呈正相关,与估算肾小球滤过率(eGFR)(r=-0.84,P<0.01)呈负相关。受试者工作特征(ROC)曲线显示,以RI=0.70为判定DN患者肾功能轻度受损[GFR<90 ml/(min·1.73 m~2)]的截断参考值,其敏感度为84.1%,特异度为92.9%;RI高于0.70者AA-IMT明显较低于者增厚(P<0.05)。AA-IMT及e GFR是肾动脉RI值的独立影响因素(P均<0.05)。结论应用彩色超声多普勒技术可无创获得DN患者肾内动脉RI值和腹主动脉AA-IMT,客观、便捷地评价其微血管和大血管受损。更多还原

【Abstract】 Objective To observe the correlation of intra-renal arterial resistance index(RI) and abdominal aortic intima-media thickness(AA-IMT) in type 2 diabetic nephropathy(DN) patients with color Doppler ultrasonography. Methods Ninety-three patients with type 2 DN were enrolled, and 35 healthy volunteers were enrolled as control group(group A). DN patients were divided into 3 groups according to the level of glomerular filtration rate(GFR), i.e. group B(n=33)with GFR≥90 ml/(min·1.73 m~2), group C(n=31) with 60 ml/(min·1.73 m~2)≤GFR<90 ml/(min·1.73 m~2) and group D(n=29) with GFR<60 ml/(min·1.73 m~2). The intra-renal arterial RI and AA-IMT were obtained with color Doppler ultrasonography. Results The values of RI and AA-IMT of group B, C, D were higher than those of group A(all P<0.05), while those of group C, D were higher than group B(all P<0.05), and RI and AA-IMT of group D were higher than those of group C(both P<0.05). RI was positively correlated with AA-IMT(r=0.90, P<0.01), glycosylated hemoglobin(r=0.58, P<0.01), glucose(r=0.66, P<0.01), total cholesterol(r=0.42, P<0.01), low density lipoprotein(r=0.03, P<0.01), creatinine(r=0.64, P<0.01), uric acid(r=0.54, P<0.01) and negatively correlative with estimated GFR(eGFR)(r=-0.84, P<0.01), respectively. Taken RI=0.70 as the cut-off point as an indicator of mild renal damage(GFR<90 ml/[min·1.73 m~2])of DN patients, patients with RI above 0.70 had higher AA-IMT than those with RI lower values(P<0.05), and the sensibility was 84.1%, specificity was 92.9%. AA-IMT and eGFR were independent predictors of RI. Conclusion The intra-renal arterial RI and AA-IMT in the patients of type 2 DN can be noninvasively obtained with color Doppler ultrasonography for evaluation on microvascular and macrovascular injuries of type 2 DN patients.更多还原