IgA肾病磁共振血氧水平依赖成像测量值与其滤过功能及病理的相关性研究

Blood oxygenation level-dependent functional magnetic resonance imaging in evaluation of glomerular filtration rate and pathology in IgA nephropathy

摘要:

目的  探究IgA肾病（IgAN）患者磁共振血氧水平依赖（BOLD）成像测量值与其滤过功能及病理的相关性。方法  选取35例IgAN患者作为研究组，20例健康志愿者作为对照组，所有受试者采用3.0T MR扫描仪进行双侧肾脏BOLD成像，测量肾脏皮髓质R2?鄢值。研究组对象采用99Tcm-DTPA闪烁扫描测定分肾的（GFR），并根据Lee氏评级系统及Katafuchi评分标准，对IgAN患者进行病理分级与评分。比较对照组与IgAN肾小球滤过率病各亚组之间肾脏皮髓质R2?鄢值的差异；分析IgAN组分肾皮髓质R2?鄢值与GFR值的相关性；研究组右肾皮髓质R2?鄢值与病理积分的相关性。结果  对照组及IgAN各亚组的肾脏皮质R2?鄢值小于髓质（P <0.05），对照组与IgAN各亚组之间皮、髓质R2?鄢值差异有统计学意义（P <0.05），但IgANⅠ级组与对照组之间的皮、髓质R2?鄢值差异无统计学意义（P >0.05）。研究组分肾皮、髓质R2?鄢值与GFR值呈负相关（P <0.05）；研究组的右肾皮、髓质R2?鄢值与病理积分呈正相关（P <0.05）。结论  磁共振BOLD成像在IgAN中的应用具有可行性，尤其对评价肾脏滤过功能及病理变化有一定的临床价值，但对早期病变缺乏敏感性。

关键词:

 ; IgA肾病;血氧水平依赖成像;肾小球滤过率;病理

Abstract:

Objective To study the correlation of the blood oxygenation level-dependent (BOLD) imaging measurements with glomerular filtration rate (GFR) and Katafuchi scores in IgA nephropathy. Methods Thirty-five patients with IgA nephropathy and twenty healthy volunteers were enrolled in this study. All of the subjects underwent studies on 3.0T MR scanner to obtain the BOLD imaging measurements. The GFR was calculated with 99Tcm-DTPA scintigraphy. The grades and the pathological damage scores of IgA nephropathy were evaluated according to the Lee classification and the Katafuchi system. The R2* values were compared between the control group and IgA nephropathy groups of different grades. The correlation between the R2* values and GFR was analyzed. The correlation between the R2* values and Katafuchi scores was analyzed. Results The renal cortical R2* values were lower than the medulla values in both the control and IgA nephropathy groups (P < 0.05). There were statistically significant differences in renal cortical and medulla R2* values between the control group and each of the IgA nephropathy subgroups (P < 0.05). But there was no significant difference in renal cortical and medulla R2* values between the IgA N I group and the control group (P > 0.05). There was a negative correlation between the renal cortical and medulla R2* values and the GFR (P < 0.05). A positive correlation was found between the renal cortical and medulla R2* values and the Katafuchi scores (P < 0.05). Conclusions The blood oxygenation level-dependent imaging was applicable on IgA nephropathy, which could be used for assessing the renal filtration function and the pathological damage. However, BOLD imaging lacks sensitivity to early renal disease.

Key words:

IgA nephropathy; blood oxygenation level-dependent imaging; glomerular filtration rate; pathology