糖尿病合并高血压患者肾实质弹性的影响因素分析
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摘要
目的探讨影响糖尿病合并高血压患者肾实质弹性的因素。方法选取2016年8月至2017年3月在温州医科大学附属第二医院的住院患者167例,根据是否患糖尿病、高血压将167例患者分为3组,单纯糖尿病(DM)组、单纯高血压(HP)组及糖尿病合并高血压(DM+HP)组,同时选取50名健康志愿者为健康对照组。收集所有被检者基本临床资料,检测常规实验室指标,采用声触诊组织定量分析(VTQ)测量每个被检者左肾实质的剪切波速度(SWV),对上述各组间计量参数进行单因素方差分析,SWV值与各因素的联系采用多元逐步线性回归分析。结果 DM、HP及DM+HP组SWV值比较,DM+HP组高于DM组与HP组[(2.62±0.35)m/s vs(2.44±0.32)m/s,(2.62±0.35)m/s vs(2.49±0.27)m/s],差异均有统计学意义(t=-2.854,-2.198,P均<0.05),3组均高于健康对照组[(2.01±0.22)m/s],差异均有统计学意义(t=-7.854,-9.783,-10.787,P均<0.05)。多元线性回归分析显示,SWV与糖尿病病程、高血压病程、左肾实质厚度、左肾动脉主干血流阻力指数(RI)和尿酸有线性回归关系(标准化回归系数b′=0.488、0.159、-0.187、0.151、0.123,P均<0.05),其中与糖尿病病程、高血压病程、左肾动脉主干血流RI、尿酸呈正相关,与左肾实质厚度呈负相关。结论与肾实质弹性存在明显相关的主要因素有糖尿病病程、高血压病程、左肾实质厚度、左肾动脉主干血流RI和尿酸,对临床预防或延缓糖尿病合并高血压患者肾实质弹性改变有一定的指导作用。
Objective To investigate the factors affecting renal parenchymal elasticity in diabetic patients with hypertension. Methods According to the presence of diabetes and hypertension, 167 patients were divided into three groups: simple diabetes mellitus(DM) group, simple hypertension(HP) group and diabetes mellitus combined with hypertension(DM + HP) group. Meanwhile, 50 healthy volunteers were selected as control group. The basic clinical data of subjects were collected, routine laboratory tests were detected, and virtual touch quantization(VTQ) was used to measure the left renal shear wave velocity(SWV). Then one-way ANOVA was used to analyze the measurement parameters among the above groups, and the relationship between SWV values and various factors was analyzed by multiple stepwise linear regressionanalysis. Results For SWV, there was significant difference among 4 groups. The SWV values in group DM + HP were greater than that in group DM and group HP [(2.62±0.35) m/s vs(2.44±0.32) m/s,(2.62± 0.35) m/s vs(2.49±0.27) m/s], the differences were statistically significant(t=-2.854,-2.198, all P < 0.05). And all three patient groups had greater values of renal SWV than that of control group [(2.01±0.22) m/s], the differences were statistically significant(t=-7.854,-9.783,-10.787, all P < 0.05). Multiple linear regression analysis showed that SWV had linear relationship with duration of diabetes, duration of hypertension, left renal parenchymal thickness, left renal artery blood flow resistance index(RI) and uric acid(standard regression coefficient b′=0.488, 0.159,-0.187, 0.151, 0.123, P < 0.05, respectively). In details, SWV was positively correlated with duration of diabetes, duration of hypertension, left renal artery blood flow RI and uric acid, while negatively correlated with the left renal parenchymal thickness. Conclusions The main factors related to the elasticity of renal parenchyma were duration of diabetes, duration of hypertension, left renal parenchymal thickness, left renal artery blood flow RI and uric acid, which can be helpful for clinical prevention for renal parenchymal change in diabetic patients with hypertension.
Objective To investigate the factors affecting renal parenchymal elasticity in diabetic patients with hypertension. Methods According to the presence of diabetes and hypertension, 167 patients were divided into three groups: simple diabetes mellitus(DM) group, simple hypertension(HP) group and diabetes mellitus combined with hypertension(DM + HP) group. Meanwhile, 50 healthy volunteers were selected as control group. The basic clinical data of subjects were collected, routine laboratory tests were detected, and virtual touch quantization(VTQ) was used to measure the left renal shear wave velocity(SWV). Then one-way ANOVA was used to analyze the measurement parameters among the above groups, and the relationship between SWV values and various factors was analyzed by multiple stepwise linear regressionanalysis. Results For SWV, there was significant difference among 4 groups. The SWV values in group DM + HP were greater than that in group DM and group HP [(2.62±0.35) m/s vs(2.44±0.32) m/s,(2.62± 0.35) m/s vs(2.49±0.27) m/s], the differences were statistically significant(t=-2.854,-2.198, all P < 0.05). And all three patient groups had greater values of renal SWV than that of control group [(2.01±0.22) m/s], the differences were statistically significant(t=-7.854,-9.783,-10.787, all P < 0.05). Multiple linear regression analysis showed that SWV had linear relationship with duration of diabetes, duration of hypertension, left renal parenchymal thickness, left renal artery blood flow resistance index(RI) and uric acid(standard regression coefficient b′=0.488, 0.159,-0.187, 0.151, 0.123, P < 0.05, respectively). In details, SWV was positively correlated with duration of diabetes, duration of hypertension, left renal artery blood flow RI and uric acid, while negatively correlated with the left renal parenchymal thickness. Conclusions The main factors related to the elasticity of renal parenchyma were duration of diabetes, duration of hypertension, left renal parenchymal thickness, left renal artery blood flow RI and uric acid, which can be helpful for clinical prevention for renal parenchymal change in diabetic patients with hypertension.
引文
1俞菊梅.糖尿病合并高血压的治疗进展[J].江西医药,2013,48(7):650-653.
2单君,江泉,陈庆,等.声脉冲辐射力成像在糖尿病患者肾脏检查中的应用[J].临床超声医学杂志,2014,15(8):527-529.
3 Sarvazyan AP,Urban MW,Greenleaf JF.Acoustic waves in medical imaging and diagnostics[J].Ultrasound Med Biol,2013,39(7):1133.
4中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中华糖尿病杂志,2014,6(7):447-498.
5陈建华,宋和平,陆瑾.国内外高血压诊断标准比较[J].中西医结合心脑血管病杂志,2014,12(5):527-528.
6 Doherty JR,Trahey GE,Nightingale KR,et al.Acoustic radiation force elasticity imaging in diagnostic ultrasound[J].IEEE Trans Ultrason Ferroelectr Freq Controlferroelectrics,and frequency control.″,2013,60(4):685-701.
7钟婷婷,刘艳君,彭凌燕,等.实时剪切波弹性成像定量评价肾间质纤维化的相关研究[J].中华超声影像学杂志,2017,26(1):58-64.
8杨敏芳,杨海超,李晶,等.声触诊组织定量技术在慢性肾病诊断中的应用及影响因素[J/CD].中华医学超声杂志(电子版),2016,13(2):108-112.
9薛立云,闻捷先,陆清,等.声触诊组织量化技术评估组织硬度的影响因素分析[J].中华超声影像学杂志,2012,21(6):526-528.
10周慧,吴秀英,崔凌凌,等.痛风与非痛风人群高血压相关因素对比分析[J].中华内分泌代谢杂志,2017,33(2):98-102.
11赵淑香.社区老年人高血压与高血糖、高血脂的相关性调查[J].国际检验医学杂志,2016,37(11):1540-1541.
12魏秋菊,李红,杜菲,等.肾脏超声检查在不同时期糖尿病肾病患者诊治中的价值[J].中国老年学杂志,2017,37(2):350-352.
13 Ghadirpour A,Tarzamni MK,Naghavi-Behzard M,et al.Renal vascular Doppler ultrasonographic indices and carotid artery intimamedia thickness in diabetic nephropathy[J].Med Ultrason,2014,16(2):95-99.
14唐业欢,潘晶晶,王海屹,等.不同年龄段健康成人肾脏表观扩散系数值的观察[J].中华医学杂志,2014,94(13):1014-1016.
15罗成建,欧玉珍,刘洋.2型糖尿病患者尿酸水平与肾功能关系[J].中国医学创新,2017,14(4):35-38.
2单君,江泉,陈庆,等.声脉冲辐射力成像在糖尿病患者肾脏检查中的应用[J].临床超声医学杂志,2014,15(8):527-529.
3 Sarvazyan AP,Urban MW,Greenleaf JF.Acoustic waves in medical imaging and diagnostics[J].Ultrasound Med Biol,2013,39(7):1133.
4中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中华糖尿病杂志,2014,6(7):447-498.
5陈建华,宋和平,陆瑾.国内外高血压诊断标准比较[J].中西医结合心脑血管病杂志,2014,12(5):527-528.
6 Doherty JR,Trahey GE,Nightingale KR,et al.Acoustic radiation force elasticity imaging in diagnostic ultrasound[J].IEEE Trans Ultrason Ferroelectr Freq Controlferroelectrics,and frequency control.″,2013,60(4):685-701.
7钟婷婷,刘艳君,彭凌燕,等.实时剪切波弹性成像定量评价肾间质纤维化的相关研究[J].中华超声影像学杂志,2017,26(1):58-64.
8杨敏芳,杨海超,李晶,等.声触诊组织定量技术在慢性肾病诊断中的应用及影响因素[J/CD].中华医学超声杂志(电子版),2016,13(2):108-112.
9薛立云,闻捷先,陆清,等.声触诊组织量化技术评估组织硬度的影响因素分析[J].中华超声影像学杂志,2012,21(6):526-528.
10周慧,吴秀英,崔凌凌,等.痛风与非痛风人群高血压相关因素对比分析[J].中华内分泌代谢杂志,2017,33(2):98-102.
11赵淑香.社区老年人高血压与高血糖、高血脂的相关性调查[J].国际检验医学杂志,2016,37(11):1540-1541.
12魏秋菊,李红,杜菲,等.肾脏超声检查在不同时期糖尿病肾病患者诊治中的价值[J].中国老年学杂志,2017,37(2):350-352.
13 Ghadirpour A,Tarzamni MK,Naghavi-Behzard M,et al.Renal vascular Doppler ultrasonographic indices and carotid artery intimamedia thickness in diabetic nephropathy[J].Med Ultrason,2014,16(2):95-99.
14唐业欢,潘晶晶,王海屹,等.不同年龄段健康成人肾脏表观扩散系数值的观察[J].中华医学杂志,2014,94(13):1014-1016.
15罗成建,欧玉珍,刘洋.2型糖尿病患者尿酸水平与肾功能关系[J].中国医学创新,2017,14(4):35-38.
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