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目的探讨弥散张量成像(DTI)在慢性肾小球肾炎(CGN)中的应用价值。方法根据估算肾小球滤过率(eGFR),83例CGN患者分为慢性肾脏病(CKD)Ⅰ期组(eGFR≥90 ml·min~(-1)·1.73 m~(-2),38例)、Ⅱ期组(eGFR 60~89 ml·min~(-1)·1.73 m~(-2),25例)、Ⅲ~Ⅴ期组(eGFR<60 ml·min~(-1)·1.73 m~(-2),20例)。Ⅰ期、Ⅱ期组患者行肾活检,并按病理积分分为P1组(≤5分,15例)、P2组(6~9分,16例)、P3组(10~14分,17例)和P4组(≥15分,15例)。另设健康志愿者25例为对照组。检测血清肌酐、血清胱抑素C和24-h尿蛋白。行DTI检查,测量肾皮质和肾髓质的各向异性分数(FA)值。结果 CKD各组肾髓质FA值均低于对照组(P<0.05),且不同CKD分期组肾髓质FA值差异均有统计学意义(P<0.05);CKDⅢ~Ⅴ期组肾皮质FA值低于CKDⅠ期、Ⅱ期组及对照组(P<0.05)。受试者肾髓质FA值均高于肾皮质FA值(P<0.05)。肾皮质及肾髓质FA值与eGFR呈正相关(P<0.05),与肌酐、胱抑素C呈负相关(P<0.05)。与对照组比较,各病理亚组肾髓质FA值均降低(P<0.05),病理分组间肾髓质FA值差异均有统计学意义(P<0.05)。结论肾髓质FA值更能反映CGN患者肾脏功能和病理改变的严重程度。
Objective To investigate the value of diffusion tensor imaging (DTI) in chronic glomerulonephritis (CGN). Methods According to the estimated glomerular filtration rate (eGFR), 83 CGN patients were divided into group Ⅰ (eGFR≥90 ml · min ~ (-1) · 1.73 m -2, 38 (EGFR 60 ~ 89 ml · min -1 · 1.73 m -2, 25 cases), group Ⅲ ~ Ⅴ (eGFR 60 ml · min -1 1.73 m -2, 20 cases). The patients in stage I and II were examined by renal biopsy, and divided into P1 group (≤5 points, 15 cases), P2 group (6 ~ 9 points, 16 cases), P3 group (10-14 points, 17 cases ) And P4 group (≥15 points, 15 cases). Another 25 healthy volunteers as a control group. Serum creatinine, serum cystatin C and 24-h urinary protein were detected. Line DTI examinations were performed to measure the anisotropic fraction (FA) values of the renal cortex and medulla. Results The renal medulla FA values of CKD groups were significantly lower than those of the control group (P <0.05), and there were significant differences in the renal medulla FA between different CKD stages (P <0.05) Values were lower than those of CKD stage I, II and control groups (P <0.05). The renal medulla FA values were higher than the renal cortical FA values (P <0.05). FA values of renal cortex and medulla were positively correlated with eGFR (P <0.05), but negatively correlated with creatinine and cystatin C (P <0.05). Compared with the control group, the FA of renal medulla decreased in all pathological groups (P <0.05), and the difference of FA in medulla between pathological groups was statistically significant (P <0.05). Conclusion The renal medulla FA value can better reflect the severity of renal function and pathological changes in patients with CGN.