| BackgroundType 2 diabetes is a chronic metabolic disease caused by defective insulin secretion and/or insulin resistance.Under the stimulation of chronic hyperglycemia,a variety of intracellular signal transduction pathways are activated,and glucose toxicity products are produced,which in turn damage capillary endothelial cells,resulting in capillary basement membrane thickening and extracellular matrix deposition,causing systemic microvascular disease.Type 2 diabetic nephropathy(T2DN)is one of its main microvascular complications.The pathological changes of early nephropathy mainly involve the glomeruli distributed in the renal cortex,and the glomeruli are composed of a large number of capillary clusters.The onset of T2DN is insidious.Once it enters the massive proteinuria stage,the rate of progression to end-stage renal disease is approximately 14timesthatofotherkidneydisease.Therefore,early diagnosis,prevention and delay of the occurrence and development of diabetic nephropathy can improve the survival rate of patients with type 2 diabetes.Improving their quality of life is of great significance.At present,the golden diagnosis of diabetic nephropathy is still based on the results of kidney pathology,but because of its invasiveness and high price,patient acceptance is low.According to relevant guidelines in China,the clinical diagnosis of diabetic nephropathy is based on urine microalbumin,and its evaluation index is urinary albumin excretion rate(UAE/AER)or ACR.In recent years,scholars in related fields have established related models for evaluating diabetic nephropathy using clinical,laboratory and ultrasound parameters as joint indicators,discussed its effectiveness in diagnosing diabetic nephropathy,and achieved corresponding results.However,the research on the evaluation of early kidney disease has not been reported in the literature.Virtual Touch tissue quantification(VTQ)technology has been widely used in the differential diagnosis of tissue fibrosis,inflammation,and benign and malignant nodules in recent years.Our team also applies this technology to focus on pancreatic fibrosis and whole body in T2DM patients.The relationship between microvascular complications was discussed on multiple levels,and it was found that the pancreatic SWV value is closely related to pancreatic fibrosis and systemic microvascular disease,and certain results have been obtained(respectively published in European Journal of Radiology and Gastrointestinal Imaging),which laid a good foundation for the smooth progress of this research.PurposeThis study is based on multimodal ultrasound omics technology(two-dimensional ultrasound,Doppler ultrasound and elastography technology),combined with multiple clinical and laboratory indicators,seeking a comprehensive diagnostic model that can evaluate early nephropathy of type 2 diabetes,and discuss Its clinical diagnostic efficiency and application value.MethodThe diabetic patients enrolled in this study all met the diabetes diagnostic criteria set by the World Health Organization in 1999.There were a total of 139 cases.According to the 2017 China Type 2Diabetes Prevention and Control Guidelines,A1 stage ACR<30mg/g was considered as the simple diabetes group,and A2 Stage ACR30mg/g-300mg/g is the early diabetic nephropathy group.There were 104 patients in the simple diabetes group(75 males and 29females,with an average age of 52.77±10.02 years);35 patients in the early diabetic nephropathy group(28 males and 7 females,with an average age of 55.17±10.41 years).In addition,30 healthy volunteers were selected as the normal control group(18 males and 12females,with an average age of 44.07±11.62 years).A Siemens Acuson S2000 ultrasound instrument equipped with VTQ analysis software was used to perform two-dimensional ultrasound(measuring renal cortex thickness and medulla thickness)on each patient’s kidney,and obtain spectral Doppler parameters(including interlobular)under the guidance of color Doppler.Arterial Vsmax,Vdmin,RI and PI),elastography examination(measure the elasticity of renal cortex and medulla),record the measurement data,and take the average value into the data for statistical analysis.The age,gender,course of disease,BMI,systolic blood pressure and diastolic blood pressure of the enrolled patients were recorded.In the morning,fasting 8-12h venous blood was collected for FCP,HbA1C,TG,TC,HDL-C,LDL-C,Urea,UA,Scr,RBP,Cys-C.Take random urine to measure ACR.Use SPSS 26.0 and Med Calc software to analyze the data.After normality test,rank sum test or one-way analysis of variance is used to compare measurement data between groups,and chi-square test is used to compare count data between groups;through binary logistic regression analysis Explore the independent related factors that affect the occurrence of early nephropathy of type 2 diabetes,and construct a regression equation;use this equation as a comprehensive diagnostic model to draw ROC curve to evaluate the diagnostic efficacy of the model for early nephropathy of type 2 diabetes;P<0.05 means statistical difference.Result1.Comparison of general clinical data:Compared with the simple diabetes group,the early diabetic nephropathy group has statistical differences in the course of disease,systolic blood pressure,and diastolic blood pressure(P<0.05);compared with the normal control group,the early diabetic nephropathy group has statistical differences in age,BMI,systolic blood pressure and diastolic blood pressure.Significance(P<0.05),age,BMI,and systolic blood pressure were statistically different in the simple diabetes group(P<0.05).2.Comparison of laboratory indicators:Compared with the early diabetic nephropathy group,HbA1C,RBP,and Scr were statistically different(P<0.05);compared with the normal control group,the early diabetic nephropathy group had statistically significant differences in TG,HbA1C,RBP,and Cys-C(P<0.05).There were statistical differences in TG,HDL-C and HbA1C in the simple diabetes group(P<0.05).3.Comparison of ultrasound parameters:Compared with the early diabetic nephropathy group and the simple diabetes group,the renal cortex elasticity,interlobular artery Vsmax,Vdmin,RI and PI were statistically different(P<0.05);compared with the normal control group,the early diabetic nephropathy group and the simple diabetes group The differences in renal cortex elasticity,and the renal medulla elasticity interlobular artery Vsmax,Vdmax,Vdmin,RI and PI were statistically significant(P<0.05).4.Analysis of independent related factors affecting the occurrence of early nephropathy in type 2 diabetes:4.1 Single factor logistic regression analysis of early nephropathy in type 2 diabetes:Taking the presence or absence of early T2DN as the dependent variable,general clinical data,laboratory indicators,and ultrasound measurements as independent variables for single-factor logistic regression analysis,the results showed that the course of disease,systolic blood pressure,diastolic blood pressure,HbA1C,RBP,renal cortex elasticity,Vsmax,Vdmin,RI and PI of interlobular artery may be related factors that affect the occurrence of early nephropathy in type 2 diabetes(P<0.05).4.2 Multi-factor logistic regression analysis of early nephropathy in type 2 diabetes:Multivariate logistic regression analysis with the presence or absence of early T2DN as the dependent variable and the statistically significant variables in the univariate logistic regression analysis as independentvariablesshowedthatsystolicblood pressure,HbA1C,RBP,renal cortex elasticity and interlobular artery RI It is an independent related factor affecting the occurrence of early nephropathy in type 2 diabetes(P<0.05).5.To compare the diagnostic efficiency of renal cortex elasticity and comprehensive diagnostic models for early nephropathy of type 2diabetes:5.1 The diagnostic efficacy of renal cortex elasticity for early nephropathy of type 2 diabetesThe area under the ROC curve(AUC)of renal cortex elasticity is0.747.The optimal cutoff value is 2.80 m/s,sensitivity is94.3%,specificity is 45.2%,positive predictive value is 37.1%,negative predictive value is 96.0%,accuracy 77.9%.5.2 The diagnostic efficacy of a comprehensive diagnostic model for early nephropathy of type 2 diabetesAccording to the results of multi-factor logistic regression analysis,a regression equation was constructed:the obtained multi-factor logistic regression equation:Logit(early T2DN)=-21.103+0.063*SBP+0.627*HbA1C+0.085*RBP-4.099*renalcortex elasticity+2.064*interlobular artery RI~*,using this equation as a comprehensive diagnostic model,draw the ROC curve,and get the area under the ROC curve of the comprehensive diagnostic model to be0.922,the best critical The value is 0.323,the sensitivity is 82.9%,the specificity is 88.5%,the positive predictive value is 50.0%,the negative predictive value is 83.5%,and the accuracy is 74.8%.5.3 Comparing the difference in diagnostic efficacy of renal cortex elasticity and comprehensive diagnostic modelsThrough Medcalc software analysis,the diagnostic efficiency of the comprehensive diagnostic model was significantly better than that of a single renal cortex elasticity,and the difference was statistically significant(P<0.05).Conclusion(1)Systolic blood pressure,HbA1C,RBP,renal cortex elasticity and interlobular artery RI are independent related factors that affect the development of early nephropathy in type 2 diabetes.(2)Based on multimodal ultrasound omics technology,a comprehensive diagnostic model for assessing early nephropathy of type 2 diabetes was constructed.Its diagnostic efficiency is significantly better than a single index of renal cortex elasticity,and its clinical application prospects are worth looking forward to. |
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