Objective To investigate the value of ultrasonic integrated backscatter(IBS) technology applied to quantitative assessment of diabetic nephropathy of different clinical stages.Methods One hundred and eight patients with diabetic nephropathy were divided into GroupⅠ(stageⅠ,n=24),GroupⅡ(stageⅡ,n=20),GroupⅢ(stageⅢ,n=22),GroupⅣ(stageⅣ,n=22),GroupⅤ(stageⅤ,n=20),and 26 healthy volunteers during the same period were enrolled in normal control group.Three ultrasonic parameters of IBS were measured in renal cortex,renal medulla and renal sinus,including peak-peak intensity(PPI),average image intensity(AII) and standard deviation of image intensity(SDI),and the AII of renal cortex and medulla was standardized(AII%).The ultrasonic parameters with statistical difference were analyzed by ROC curve, and the diagnostic thresholds for diabetic nephropathy and its different stages were obtained.Results The comparison of the AII% of renal cortex and renal medulla among all groups showed that the AII%was in a sequence of control group0.05) were observed.ROC curve analysis revealed that area under the curves of renal cortex AII%and renal medulia AII%for diabetic nephropathy and its different stages were both more than 0.7(P<0.05).The diagnostic thresholds of renal cortex AII% for diabetic nephropathy,stageⅠand Ⅱ,stage Ⅲ, stageⅣand stageⅤwere 0.732,0.725,0.744,0.789 and 0.815,respectively.While the diagnostic thresholds of renal medulla AII%for diabetic nephropathy,stageⅠandⅡ,stageⅢ,stageⅣand stageⅤwere 0.625,0.619,0.666,0.706 and 0.740,respectively.Conclusion The technology of IBS can discover diabetic nephropathy in early stage and monitor the progress of renal damage,and it may become an important approach to clinical staging assessment of diabetic nephropathy.%目的 探讨超声背向散射积分( IBS)技术在定量评估糖尿病肾病不同临床分期中的应用价值. 方法 糖尿病肾病患者108例按临床分期分为Ⅰ期(Ⅰ组)24例、Ⅱ期(Ⅱ组)20例、Ⅲ期(Ⅲ组)22例、Ⅳ期(Ⅳ组)22 例、Ⅴ期(Ⅴ组) 20例;并选择同期健康志愿者26例为正常对照组. 分别测量肾皮质、肾髓质、肾窦的IBS 3 项超声参数,包括峰-峰强度( PPI)、平均强度( AII)、图像强度标准差( SDI) ,计算肾皮质及肾髓质AII标准化值( AII%). 通过ROC曲线对有统计学差异的超声参考值进行分析,得出糖尿病肾病及不同临床分期糖尿病肾病诊断界限值. 结果 肾皮质及肾髓质AII%在各组间的比较结果显示,对照组<Ⅰ组、Ⅱ组<Ⅲ组<Ⅳ组<Ⅴ组(P<0.05),Ⅰ组与Ⅱ组无明显差异(P>0.05). 通过ROC曲线分析得出糖尿病肾病及其不同临床分期肾皮质及肾髓质AII%曲线下面积均>0.7(P<0.05),其中肾皮质AII%糖尿病肾病的诊断界限值0.732,Ⅰ期、Ⅱ期的诊断界限值0.725,Ⅲ期的诊断界限值0.744,Ⅳ期的诊断界限值0.789,Ⅴ期的诊断界限值0.815;肾髓质AII%糖尿病肾病的诊断界限值0.625,Ⅰ期、Ⅱ期的诊断界限值0.619,Ⅲ期的诊断界限值0.666,Ⅳ期的诊断界限值0.706,Ⅴ期的诊断界限值0.740. 结论 IBS技术能够早期发现糖尿病肾病,并能够监测肾损害程度的进展,可作为临床上糖尿病肾病不同临床分期评估的重要方法.
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