CAJ | 학술논문

目的：利用多层螺旋 CT(MSCT)灌注扫描探讨糖尿病(DM)患者早期肾脏血流灌注变化特点,及其与空腹血糖的关系。方法对30例符合临床诊断标准的2型糖尿病(T2DM)病程5年内患者[糖尿病肾病(DN)血糖控制不良组与 DN 血糖控制良好组各15例],以及正常对照组15例,使用64层螺旋 CT 行双侧肾脏灌注扫描,获得各组双肾皮质灌注参数：血流量(BF)、血容量(BV)、平均通过时间(MTT)、毛细血管表面通透性(PS),同时测量各例的灌注前及灌注后第3天空腹血糖、血尿素氮、血肌酐、血尿酸数值,并估算其肾小球滤过率(C-GFR),将所获得数值进行统计分析。结果(1)DN 血糖控制不良组的平均 BF、平均 BV、平均PS 值减低,平均 MTT 明显延长,平均 BF、平均 MTT 与正常组比较有统计学意义(P <0.05)；DN 血糖控制良好组平均 BF、平均BV 值增高,平均 MTT 延长,与正常组比较均有统计学意义(P <0.01),DN 血糖控制不良组与 DN 血糖控制良好组比较,平均 BF、平均 BV 值减低,平均 MTT 延长,均有统计学意义(P <0.01)。(2)空腹血糖与平均 BF、平均 MTT 相关性最高,并与肾脏灌注参数存在线性相关。(3)正常对照组、DN 组肾脏 CT 灌注成像检查前、后第3天肾小球滤过率无统计学意义(P >0.05)。结论MSCT 肾脏灌注指标 BF、BV、MTT 可反映早期糖尿病肾脏血流灌注特点,空腹血糖影响肾脏的平均 BF、平均 MTT。
목적：이용다층라선 CT(MSCT)관주소묘탐토당뇨병(DM)환자조기신장혈류관주변화특점,급기여공복혈당적관계。방법대30례부합림상진단표준적2형당뇨병(T2DM)병정5년내환자[당뇨병신병(DN)혈당공제불량조여 DN 혈당공제량호조각15례],이급정상대조조15례,사용64층라선 CT 행쌍측신장관주소묘,획득각조쌍신피질관주삼수：혈류량(BF)、혈용량(BV)、평균통과시간(MTT)、모세혈관표면통투성(PS),동시측량각례적관주전급관주후제3천공복혈당、혈뇨소담、혈기항、혈뇨산수치,병고산기신소구려과솔(C-GFR),장소획득수치진행통계분석。결과(1)DN 혈당공제불량조적평균 BF、평균 BV、평균PS 치감저,평균 MTT 명현연장,평균 BF、평균 MTT 여정상조비교유통계학의의(P <0.05)；DN 혈당공제량호조평균 BF、평균BV 치증고,평균 MTT 연장,여정상조비교균유통계학의의(P <0.01),DN 혈당공제불량조여 DN 혈당공제량호조비교,평균 BF、평균 BV 치감저,평균 MTT 연장,균유통계학의의(P <0.01)。(2)공복혈당여평균 BF、평균 MTT 상관성최고,병여신장관주삼수존재선성상관。(3)정상대조조、DN 조신장 CT 관주성상검사전、후제3천신소구려과솔무통계학의의(P >0.05)。결론MSCT 신장관주지표 BF、BV、MTT 가반영조기당뇨병신장혈류관주특점,공복혈당영향신장적평균 BF、평균 MTT。
Objective To explore the change characteristics of early renal blood infusion in patients with diabetes and its relation-ship with fasting blood sugar by using multi-slice spiral CT (MSCT)perfusion scan.Methods Thirty cases of T2DM patients within five years of disease course that meet clinical diagnostic criteria (poor DN glycemic control group and good DN glycemic control group with 1 5 cases in each group)and 1 5 cases in the control group underwent bilateral renal perfusion scan using 64-detector spiral CT,thus obtaning their cortical perfusion parameters of bilateral kidneys,including blood flow (BF),blood volume (BV),mean transit time (MTT)and capillary permeability surface (PS).At the same time,for each case,fasting glucose,blood urea nitrogen, serum creatinine and blood uric acid value on the third days after and before perfusion were also measured;the glomemlar filtration rate (C-GFR)was estimated.Statistical analysis was performed on all of these obtained values.Results (1).For the poor DN gly-cemic control group,the average BF value,average BV value and average PS value were reduced,average MTT was prolonged sig-nificantly,and compared with normal group,average BF value and average MTT were statistically significant (P <0.05);for good DN glycemic control group,average BF value and average BV value were increased,the average MTT was prolonged,and compared with the normal group,the difference was statistically significant (P <0.01);compared with the good DN glycemic control group, the average BF value and average BV value of the poor DN glycemic control group were significantly reduced,and the average MTT was significantly prolonged.(2).Fasting blood glucose had the highest correlation with average BF and average MTT and was linear-ly dependent with renal perfusion parameters.(3).The glomemlar filtration rate was not statistically significant (P >0.05)for both normal control group and DN groups in the third day before and after renal CT perfusion imaging examination.Conclusion BF,BV and MTT of MSCT perfusion scan can reflect the characteris-ticsof early renal blood infusion in patients with diabetes.And changes of fasting blood sugar in patients with diabetes may influence mean BF and mean MTT of kidney.