Diagnostic value of quantitative contrast-enhanced ultrasound (CEUS) for early detection of renal hyperperfusion in diabetic kidney disease
Diagnostic value of quantitative contrast-enhanced ultrasound (CEUS) for early detection of renal hyperperfusion in diabetic kidney disease
复制标题
定量超声造影（CEUS）对糖尿病肾病早期肾过度灌注的诊断价值
DOI：
10.1007/s40620-015-0183-3
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发表时间：
2015-12-01
影响因子：
3.4
通讯作者：
Song, Ya-Xiang
中科院分区：
文献类型：
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作者：
Wang, Ling;Wu, Jian;Song, Ya-Xiang
目的探讨定量超声造影（CEUS）对糖尿病肾病（DKD）早期肾血流灌注异常的诊断价值。材料与方法选择肾小球滤过率（eGFR）>30 ml/min/1.73 m2的DKD患者55例，正常对照组26例。临床数据记录良好。抽取血液样本用于评估肾功能，包括血尿素氮（BUN）、血清肌酐（SCr）和血清尿酸（SUA），并分析尿液样本用于总蛋白定量和各种微量蛋白标志物。根据eGFR水平将DKD患者分为早期DKD（eGFR ≥90 ml/min/1.73 m2，n = 18）和中期DKD（eGFR 30-90 ml/min/1.73 m2，n = 37）。根据尿微量白蛋白/肌酐比值（MALB/UCR）将早期DKD患者进一步分为两组：MALB/UCR <10 g/mol（n = 11）和MALB/UCR ≥10 g/mol（n = 7）。结果CEUS肾血流灌注图像清晰、清晰，并能实时显示肾血流灌注情况，并能定量分析肾血流灌注情况。根据时间序列中的回波功率信号构建相应的灌注曲线。定量分析显示，DKD早期组下降曲线下面积（AUC 2）较中期组显著增加（p < 0.05），但AUC无显著差异。进一步比较不同MALB/UCR水平的早期DKD患者，MALB/UCR ≥10 g/mol的患者的AUC、AUC 2和蛋白尿水平均显著高于低MALB/UCR的患者（p < 0.05）。此外，高MALB/UCR DKD患者的蛋白尿增加，但类似的eGFR相比，低MALB/UCR patients.Conclusionrenal微血管过度灌注可能是负责明显的蛋白尿，直到肾滤过下降DKD。AUC 2可作为DKD早期肾损害和肾微血管过度灌注的早期敏感指标。
PurposeTo investigate the diagnostic value of quantitative contrast-enhanced ultrasound (CEUS) for early detection of renal hyperperfusion in diabetic kidney disease (DKD).Materials and methods55 DKD patients with estimated glomerular filtration rate (eGFR) >30 ml/min/1.73 m2and 26 normal controls (NCs) were enrolled. Clinical data was well documented. Blood samples were drawn for evaluation of renal function including blood urea nitrogen (BUN), serum creatinine (SCr) and serum uric acid (SUA), and urine samples were assayed for total protein quantification, and various microprotein markers. According to eGFR level, DKD patients were divided into early-stage DKD (eGFR ≥90 ml/min/1.73 m2, n = 18) and middle-stage DKD (eGFR 30–90 ml/min/1.73 m2, n = 37). Based on urinary microalbumin/creatinine ratio (MALB/UCR), early-stage DKD patients were further classified into two groups: MALB/UCR <10 g/mol (n = 11) and MALB/UCR ≥10 g/mol (n = 7). Then, CEUS was performed to observe the real-time renal perfusion, and low acoustic power contrast-specific imaging was used for quantitative analysis.ResultsThe renal perfusion images of CEUS were well developed successively. The corresponding perfusion curves based on echo-power signals in time series were constructed. Quantitative analysis showed that area under the descending curve (AUC2) was significantly increased in early-stage DKD compared to middle-stage DKD (p < 0.05), but AUC showed no significant difference. Further comparison between different MALB/UCR levels of early-stage DKD showed that patients with MALB/UCR ≥10 g/mol had significantly increased levels of AUC, AUC2 and proteinuria than patients with low MALB/UCR (p < 0.05). Also, high MALB/UCR DKD patients had increased proteinuria but similar eGFR compared to low MALB/UCR patients.ConclusionRenal microvascular hyperperfusion may be responsible for overt proteinuria until decline of renal filtration in DKD. AUC2 could be an early and sensitive marker for early renal injury and renal microvascular hyperperfusion in DKD.