肾动脉脾动脉阻力指数与糖尿病肾病的相关性
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摘要
目的统计学分析肾动脉与脾动脉阻力指数(RI)以及两者的差值△RI与糖尿病肾病(DN)的相关性,探讨3个参数评估DN的可行性与可靠性。方法 257例DN患者纳入本次研究,测量每位患者的左肾肾动脉RI及脾动脉RI,并计算两者的差值△RI;同时测量颈动脉内膜厚度,收集心率、收缩压及舒张压,计算糖尿病肾病组患者的肾小球滤过率(e GFR)。采用Spearman检验计算相关系数,多元线性回归方程分析肾动脉RI、脾动脉RI及△RI的独立预测因子。结果 Spearman检验显示肾动脉RI值和脾动脉RI值与年龄、脉压、颈动脉内膜厚度呈正相关(均P <0. 01);与心率、e GFR呈负相关。△RI只与e GFR呈负相关。多元线性回归结果显示:肾动脉RI值与年龄、脉压和e GFR独立相关;脾动脉RI值与年龄、心率及脉压独立相关;△RI与e GFR独立相关,而与颈动脉内膜厚度、年龄、心率和脉压无相关性。结论肾动脉RI与肾动脉与脾动脉RI差值△RI都可以反映老年人糖尿病肾病损害情况,其中△RI因不与肾外因素相关,可靠性更高。
Objective To analyze the correlation between renal and splenic artery resistance index( RI) and the difference( △RI) in patients with diabetic nephropathy( DN),and to study the feasibility and reliability of the three parameters in evaluating DN. Methods A total of 257 DN patients were enrolled in experimental group,and 145 health outpatients were enrolled as control group. Left renal and splenic artery RI were measured,△RI were calculated,and carotid intima-media thickness( IMT) were examined by ultrasound. Age,heart rate,systolic pressure,diastolic pressure and pulse pressure were analyzed,and estimated glomerular filtration rate( e GFR) of DN patients were evaluated. The t-test,Spearman rank correlation test and multivariate regression analysis were used. Results There were significant differences in the renal artery RI,splenic artery RI,△RI,carotid IMT,systolic pressure,diastolic pressure,pulse pressure and heart rate between the two groups( P < 0. 01). In the control group,there was significant correlation between renal and splenic artery RI( r = 0. 54,P < 0. 001). There were significant correlations between renal/splenic artery RI and age( renal artery RI: r = 0. 18,P = 0. 027; splenic artery RI: r = 0. 33,P < 0. 001),and renal/splenic artery RI and carotid IMT( renal artery RI: r = 0. 19,P = 0. 022; splenic artery RI: r = 0. 33,P < 0. 001). No significant correlation was observed between renal/splenic artery RI and heart rate,systolic pressure,diastolic pressure or pulse pressure( all P >0. 05). There was no correlation between △RI and carotid IMT( r =-0. 10,P = 0. 215). In the DN group,there were positive correlations between renal/splenic artery RI and age,pulse pressure,carotid IMT( all P < 0. 01); negative correlations between renal/splenic artery RI and heart rate,e GFR. △RI had a negative correlation with e GFR. The multivariate regression analysis showed that renal artery RI was associated with IMT,age,pulse pressure and e GFR; and splenic artery RI was associated with ages,heart rate and pulse pressure. △RI was correlated with e GFR,but not with IMT,age,heart rate or pulse pressure. Conclusion Renal artery RI and △RI both could reflect renal damage in patients with DN.△RI shows higher reliability without extrarenal affecting factors.
Objective To analyze the correlation between renal and splenic artery resistance index( RI) and the difference( △RI) in patients with diabetic nephropathy( DN),and to study the feasibility and reliability of the three parameters in evaluating DN. Methods A total of 257 DN patients were enrolled in experimental group,and 145 health outpatients were enrolled as control group. Left renal and splenic artery RI were measured,△RI were calculated,and carotid intima-media thickness( IMT) were examined by ultrasound. Age,heart rate,systolic pressure,diastolic pressure and pulse pressure were analyzed,and estimated glomerular filtration rate( e GFR) of DN patients were evaluated. The t-test,Spearman rank correlation test and multivariate regression analysis were used. Results There were significant differences in the renal artery RI,splenic artery RI,△RI,carotid IMT,systolic pressure,diastolic pressure,pulse pressure and heart rate between the two groups( P < 0. 01). In the control group,there was significant correlation between renal and splenic artery RI( r = 0. 54,P < 0. 001). There were significant correlations between renal/splenic artery RI and age( renal artery RI: r = 0. 18,P = 0. 027; splenic artery RI: r = 0. 33,P < 0. 001),and renal/splenic artery RI and carotid IMT( renal artery RI: r = 0. 19,P = 0. 022; splenic artery RI: r = 0. 33,P < 0. 001). No significant correlation was observed between renal/splenic artery RI and heart rate,systolic pressure,diastolic pressure or pulse pressure( all P >0. 05). There was no correlation between △RI and carotid IMT( r =-0. 10,P = 0. 215). In the DN group,there were positive correlations between renal/splenic artery RI and age,pulse pressure,carotid IMT( all P < 0. 01); negative correlations between renal/splenic artery RI and heart rate,e GFR. △RI had a negative correlation with e GFR. The multivariate regression analysis showed that renal artery RI was associated with IMT,age,pulse pressure and e GFR; and splenic artery RI was associated with ages,heart rate and pulse pressure. △RI was correlated with e GFR,but not with IMT,age,heart rate or pulse pressure. Conclusion Renal artery RI and △RI both could reflect renal damage in patients with DN.△RI shows higher reliability without extrarenal affecting factors.
引文
[1]曾龙驿,江玮.重视糖尿病肾病发生机制的研究[J].中华医学杂志,2016,96(17):1313-1314.
[2]王文霞,贾伟平,包玉倩,等.上海社区糖尿病及糖尿病前期慢性肾脏并发症患病现状调查[J].中华医学杂志,2006,86(36):2527-2532.
[3]魏秋菊,李红,杜菲,等.肾脏超声检查在不同时期糖尿病肾病患者诊治中的价值[J].中国老年学杂志,2017,37(2):350-352.
[4] Saito J,Suzuki E,Tajima Y,et al. Increased plasma serotonin metabolite 5-hydroxyindole acetic acid concentrations are associated with impaired systolic and late diastolic forward flows during cardiac cycle and elevated resistive index at popliteal artery and renal insufficiency in type 2 diabetic patients with microalbuminuria[J]. Endocr J,2016,63(1):69-76.
[5] Mancini M,Masulli M,Liuzzi R,et al. Renal duplex sonographic evaluation of type 2 diabetic patients[J]. J Ultrasound Med,2013,32(6):1033-1040.
[6] Stefan G,Capusa C,Stancu S,et al. Abdominal aortic calcification and renal resistive index in patients with chronic kidney disease:is there a connection?[J]. J Nephrol,2014,27(2):173-179.
[7] Basturk T,Akcay M,Albayrak R,et al. Correlation between the resistive index values of renal and orbital arteries[J]. Kidney Blood Press Res,2012,35(5):332-339.
[8] Granata A,Zanoli L,Clementi S,et al. Resistive intrarenal index:myth or reality?[J]. Br J Radiol,2014,87(1038):20140004.
[9]严跃红,傅君舟,关昌杰,等.三种CKD-EPI方程在我国糖尿病肾病患者中适用性的对比研究[J].中华肾脏病杂志,2016,32(1):9-15.
[10] Insalaco M,Zamboli P,Floccari F,et al. Indication to renal biopsy in DM2 patients:potential role of intrarenal resistive index[J]. Arch Ital Urol Androl,2012,84(4):283-286.
[11] Fiorini F,Granata A,Noce A,et al. Index resistance in renal ultrasound:what is the clinical significance?[J]. G Ital Nefrol,2013,30(2). pii:gin/30. 2. 4.
[12]余晓梅,熊丽娟,郭敬东,等.彩色多普勒超声在肾移植后排斥反应诊断中的应用[J].中华器官移植杂志,2006,27(9):549-551.
[13]陈顺平,胡元平,刘景云,等.改良阻力指数判断移植肾舒张期反向血流患者预后的价值[J].中华器官移植杂志,2010,31(12):753-756.
[14]吴雪怡,李航,文煜冰,等. 2型糖尿病肾病患者肾脏病理改变与预后的临床队列研究[J].中华肾脏病杂志,2014,30(9):650-655.
[15]卞茸文,顾刘宝,吕利萍,等. 2型糖尿病患者外周血管病变与颈动脉粥样硬化的关系[J].中国糖尿病杂志,2007,15(8):478-480.
[16]张雪晗,谢海雁,姜鸿,等.不同肾小球滤过率估测公式评估北京社区老年人群肾功能和慢性肾脏疾病患病率的差异[J].中华老年医学杂志,2016,35(2):179-184.
[2]王文霞,贾伟平,包玉倩,等.上海社区糖尿病及糖尿病前期慢性肾脏并发症患病现状调查[J].中华医学杂志,2006,86(36):2527-2532.
[3]魏秋菊,李红,杜菲,等.肾脏超声检查在不同时期糖尿病肾病患者诊治中的价值[J].中国老年学杂志,2017,37(2):350-352.
[4] Saito J,Suzuki E,Tajima Y,et al. Increased plasma serotonin metabolite 5-hydroxyindole acetic acid concentrations are associated with impaired systolic and late diastolic forward flows during cardiac cycle and elevated resistive index at popliteal artery and renal insufficiency in type 2 diabetic patients with microalbuminuria[J]. Endocr J,2016,63(1):69-76.
[5] Mancini M,Masulli M,Liuzzi R,et al. Renal duplex sonographic evaluation of type 2 diabetic patients[J]. J Ultrasound Med,2013,32(6):1033-1040.
[6] Stefan G,Capusa C,Stancu S,et al. Abdominal aortic calcification and renal resistive index in patients with chronic kidney disease:is there a connection?[J]. J Nephrol,2014,27(2):173-179.
[7] Basturk T,Akcay M,Albayrak R,et al. Correlation between the resistive index values of renal and orbital arteries[J]. Kidney Blood Press Res,2012,35(5):332-339.
[8] Granata A,Zanoli L,Clementi S,et al. Resistive intrarenal index:myth or reality?[J]. Br J Radiol,2014,87(1038):20140004.
[9]严跃红,傅君舟,关昌杰,等.三种CKD-EPI方程在我国糖尿病肾病患者中适用性的对比研究[J].中华肾脏病杂志,2016,32(1):9-15.
[10] Insalaco M,Zamboli P,Floccari F,et al. Indication to renal biopsy in DM2 patients:potential role of intrarenal resistive index[J]. Arch Ital Urol Androl,2012,84(4):283-286.
[11] Fiorini F,Granata A,Noce A,et al. Index resistance in renal ultrasound:what is the clinical significance?[J]. G Ital Nefrol,2013,30(2). pii:gin/30. 2. 4.
[12]余晓梅,熊丽娟,郭敬东,等.彩色多普勒超声在肾移植后排斥反应诊断中的应用[J].中华器官移植杂志,2006,27(9):549-551.
[13]陈顺平,胡元平,刘景云,等.改良阻力指数判断移植肾舒张期反向血流患者预后的价值[J].中华器官移植杂志,2010,31(12):753-756.
[14]吴雪怡,李航,文煜冰,等. 2型糖尿病肾病患者肾脏病理改变与预后的临床队列研究[J].中华肾脏病杂志,2014,30(9):650-655.
[15]卞茸文,顾刘宝,吕利萍,等. 2型糖尿病患者外周血管病变与颈动脉粥样硬化的关系[J].中国糖尿病杂志,2007,15(8):478-480.
[16]张雪晗,谢海雁,姜鸿,等.不同肾小球滤过率估测公式评估北京社区老年人群肾功能和慢性肾脏疾病患病率的差异[J].中华老年医学杂志,2016,35(2):179-184.