MRI评价糖尿病肾病患者肾皮质灌注水平及与远期预后的相关性

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Abstract Objective To investigate the role of MRI in evaluating renal cortical perfusion level and long-term prognosis in patients with diabetic nephropathy. Methods A total of 120 patients with type 2 diabetes admitted to Shenyang First People′s Hospital from August 2016 to August 2017 were selected as the research objects. According to whether they had diabetic nephropathy (DKD), they were divided into simple diabetes (SD) group (60 cases) and DKD group (60 cases), and DKD group was further divided into mild DKD subgroup (27 cases) and moderate and severe DKD subgroup(33 cases) according to the severity of their disease. Sixty healthy people who came to Shenyang First People′s Hospital during the same period were selected as the normal control group.The incidence of adverse events(death, ≥30%increase in serum creatinine, and end-stage renal disease) was recorded during follow-up. All subjects underwent arterial spin labeling (ASL) MRI scanning, and renal blood flow (RBF) was measured by two physicians. The consistency of the results was analyzed, and the correlation between RBF and glomerular filtration rate (eGFR) was analyzed. The predictive value of RBF for long-term prognosis was evaluated by ROC curve. Results The intra-group correlation coefficient(ICC) of RBF values in SD group, DKD group and normal control group was higher than 0.90, indicating a high consistency. RBF values of SD group, mild DKD group, moderate and severe DKD group and normal control group were significantly different (P＜0.05). The RBF value of normal control group was higher than that of SD group, mild DKD group and moderate and severe DKD group. The RBF value of SD group was higher than that of mild DKD group and moderate and severe DKD group. The RBF value of mild DKD group was higher than that of moderate and severe DKD group(P＜0.05). The RBF value of renal cortex was positively correlated with eGFR value in diabetic patients (r=0.664, P＜0.05).Forty-four DKD patients were followed up for 23-38 months,with an average of(32.1±2.1) months, and 18 patients had adverse events during the follow-up. The area under ROC curve of RBF for predicting long-term prognosis was 0.821 (95%CI 0.742～0.901), and the sensitivity, specificity and accuracy were 78.2%, 85.5% and 83.2%, respectively.Conclusion ASL MRI can quantitatively assess the level of renal cortex perfusion in diabetic patients, and sensitively distinguish differences in patient prognosis, which provides a non-invasive and reproducible clinical monitoring method for the evaluation of renal function and long-term efficacy prediction of DKD patients.

Key words： MRI Diabetic nephropathy Renal cortical perfusion level Long-term prognosis

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LIU Bing. MRI evaluation of renal cortical perfusion level and its correlation with long-term prognosis in patients with diabetic nephropathy[J]. 中国当代医药, 2021, 28(28): 141-144.

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http://dangdaiyiyao.com/EN/ OR http://dangdaiyiyao.com/EN/Y2021/V28/I28/141

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