多普勒超声、声触诊组织定量技术联合血清胱抑素C在早期糖尿病肾病中的应用价值

Application value of tissue quantitative technique combined with serum cystatin C by Doppler ultrasound and acoustic palpation in early diabetic nephropathy

摘要:

目的 探讨多普勒超声、声触诊组织定量（VTQ）技术联合血清胱抑素C（CysC）在早期糖尿病肾病（DN）中的应用价值。方法 选取2020年9月—2022年9月南京中医药大学连云港附属医院收治的138例2型糖尿病（T2DM）患者为研究对象。其中，单纯T2DM患者56例，早期DN 48例，临床DN 34例。所有患者均行多普勒超声、VTQ技术诊断，并检测血清CysC水平。采用多因素Logistic逐步回归分析影响DN诊断的因素，绘制受试者工作特征（ROC）曲线分析多普勒超声、VTQ检查定量指标及CysC诊断DN及早期DN的价值。结果 多因素Logistic逐步回归分析结果显示，血肌酐［O^R =3.438（95% CI：1.415，8.356）］、肾动脉（肾门处主肾动脉）舒张末期最低血流速度（EDV）［O^R =4.121（95%CI：1.695，10.014）］、肾动脉阻力指数（RI）［O^R =4.358（95% CI：1.793，10.591）］、肾皮质剪切波速度（SWV）［O^R =4.323（95% CI：1.779，10.507）］、CysC［O^R =4.229（95% CI：1.740，10.278）］是影响DN诊断的因素（P <0.05）。ROC曲线分析结果显示，EDV（肾门处主肾动脉）、RI（肾门处主肾动脉）、SWV、CysC及四者联合诊断DN的敏感性分别为70.73%（95% CI：0.595，0.800）、73.17%（95% CI：0.621，0.821）、71.95%（95% CI：0.608，0.810）、75.61%（95% CI：0.647，0.841）、80.49%（95% CI：0.700，0.881），特异性分别为73.21%（95% CI：0.595，0.838）、80.36%（95% CI：0.672，0.893）、75.00%（95% CI：0.614，0.852）、71.43%（95% CI：0.576，0.823）、89.29%（95% CI：0.775，0.956），AUC分别为0.734（95% CI：0.639，0.828）、0.756（95% CI：0.651，0.860）、0.718（95% CI：0.608，0.827）、0.739（95% CI：0.631，0.846）、0.902（95% CI：0.837，0.968）。ROC曲线分析结果显示，EDV、RI、SWV、CysC及四者联合诊断早期DN的敏感性分别为70.83%（95% CI：0.557，0.826）、77.08%（95% CI：0.623，0.875）、72.92%（95%CI：0.579，0.843）、70.83%（95% CI：0.557，0.826）、83.33%（95% CI：0.692，0.920），特异性分别为79.41%（95% CI：0.616，0.901）、73.53%（95% CI：0.554，0.865）、76.47%（95% CI：0.584，0.886）、70.59%（95% CI：0.523，0.843）、91.18%（95% CI：0.752，0.977），AUC分别为0.770（95% CI：0.672，0.868）、0.746（95% CI：0.634，0.858）、0.761（95% CI：0.665，0.857）、0.765（95% CI：0.653，0.877）、0.910（95% CI：0.850，0.969）。结论 EDV、RI、SWV、CysC四者联合诊断早期DN可提高诊断效能。

Abstract:

Objective To investigate the application value of Doppler ultrasound, virtual touch tissue quantification (VTQ) combined with serum cystatin C (CysC) in early diabetic nephropathy (DN).Methods One hundred and thirty eight patients with type 2 diabetes mellitus (T2DM) admitted to the hospital from September 2020 to September 2022 were selected as the study objects, including 56 patients with simple T2DM, 48 patients with early stage DN, and 34 patients with clinical DN. All patients were diagnosed by Doppler ultrasound and VTQ technology, and the serum CysC level was detected. Logistic regression analysis was used to analyze the factors affecting the diagnosis of DN. Receiver operating curve (ROC) was used to analyze the value of Doppler ultrasound, VTQ and CysC in diagnosing DN and early DN.Results Logistic multivariate regression analysis showed that: serum creatinine level [O^R = 3.438 (95% CI: 1.415, 8.356) ], end-diastolic minimum blood flow velocity (EDV) (main renal artery at the renal hilum) level of renal artery [O^R = 4.121 ( 95% CI: 1.695, 10.014) ], renal artery resistance index (RI) level [O^R = 4.358 (95% CI: 1.793, 10.591) ], shear wave velocity of renal cortex (SWV) level [O^R = 4.323 (95% CI: 1.779,10.507) ], and CysC level [O^R = 4.229 (95% CI: 1.740, 10.278) ] were the factors affecting the diagnosis of DN (P < 0.05). ROC curve analysis results showed that the sensitivity of RI (main renal artery at the renal hilum), EDV (main renal artery at the renal hilum), SWV, CysC, and the combined diagnosis of DN were 70.73% (95% CI: 0.595,0.800), 73.17% (95% CI: 0.621, 0.821), 71.95% (95% CI: 0.608, 0.810), 75.61% (95% CI: 0.647,0.841), and 80.49% (95% CI: 0.700, 0.881); the specificity were 73.21% (95% CI: 0.595, 0.838), 80.36% (95% CI: 0.672, 0.893), 75.00% (95% CI: 0.614, 0.852), 71.43% (95% CI: 0.576, 0.823), and 89.29% (95% CI: 0.775, 0.956); the AUC were 0.734 (95% CI: 0.639, 0.828), 0.756 (95% CI: 0.651, 0.860), 0.718 (95% CI: 0.608, 0.827), 0.739 (95% CI: 0.631, 0.846), and 0.902 (95% CI: 0.837, 0.968). ROC curve analysis results showed that the sensitivity of EDV, RI, SWV, CysC, and the combined diagnosis of early DN were 70.83% (95% CI: 0.557, 0.826), 77.08% (95% CI: 0.623, 0.875), 72.92% (95% CI: 0.579, 0.843), 70.83% (95% CI: 0.557, 0.826), and 83.33% (95% CI: 0.692, 0.920); the specificity were 79.41% (95% CI: 0.616, 0.901), 73.53% (95% CI: 0.554, 0.865), 76.47% (95% CI: 0.584, 0.886), 70.59% (95% CI: 0.523, 0.843), and 91.18% (95% CI: 0.752, 0.977); the AUC were 0.770 (95% CI: 0.672, 0.868), 0.746 (95% CI: 0.634, 0.858), 0.761 (95% CI: 0.665, 0.857), 0.765 (95% CI: 0.653, 0.877), and 0.910 (95% CI: 0.850, 0.969).Conclusion The combination of EDV, RI, SWV and CysC can improve the diagnostic efficiency of early DN.