| Object:Measure kidney hemodynamic and volume changes in type2diabetic nephropathy after target treatment. In order to evaluate the renalfunction and study risk factors that influence renal outcomes,to provide thebasis for clinical treatment. Select part of patients who underwent renal biopsyby the guidance of ultrasound..Using a new method of VTQ to check renalparenchymal elastic changes in different course of.DN and comparing theresults of shear wave velocity with pathological findings, in order to providethe theory basis for ultrasound evaluating renal tissue elastic changes indevelopment of DN.Methods:110patients with diabetes mellitus classified into three groupsaccording to urinary albumin excretion rate(UAER):DN1:UAER<30mg;DN2:UAER:30~300mg;DN3:UAER>300mg.and compared with20cases ofcontrol group,renal size and blood flow parameters of renal arteries weremeasured and analyzed by color Doppler Ultrasound.All the patients receivedtarget treatment for ten months,patients were divided into standardgroup(A)and un-standard group (B),the standards were as follows：FPG lessthan7.0mmol/L, SBP less than130mmHg, DBP less than85mmHg. LDL-Cless than2.6m mol/L and TG less than1.7mmol/L.Using PHILIPS-IU22Doppler Ultrasound Instrument to measure kidney hemodynamic and volumechanges,observe distribution of renal blood flow and measure the distancebetween kidney surrounding vessels and renal capsular(D).Diabeticnephropathy patients who underwent renal biopsy underwent VTQ,the edgeshears wave velocity(Vs) which reflected the organizations tissue elasticcompliance was measured,The results were compared and analyzed withpathology. Record biochemical indicators before and after treatment.Result: 1Compared Kidney volume changes in DN groups1.1Compared DN groups with control group in kidney volume changes beforetreatmentkidney volume of DN1increased obviously,yet the volume of DN2startedto Shrink, when in the progress of DN3the volume reduced obviously.,thedifferences above were statistically significant(P<0.05).1.2Compared the change of kidney volume before and after treatmentkidney volume of DN1-A was larger than control group,but was smallerthan before(P<0.05).volume of DN1-B,DN2(A,B) were larger than controlgroup,but there were no changes before and after treatment. The volume ofDN3(A.B) was smaller than control group and had no changes before and aftertreatment.Above all volume changes can be find in DN-A group aftertreatment.2The changes of color Doppler flow imaging in DN groups2.1compared color Doppler flow imaging in DN groups before treatmentRenal artery branch show clearly in control group,the peripheral vasculardefect increased gradually from DN1to DN3and the distance(D)wasincreasing gradually. the difference of the distance(D) between control groupand DN groups were statistically significant (P <0.05)2.2The changes of color Doppler flow imaging in DN groups before and aftertreatmentThe distance(D) of DN1-A and DN2-A groups were decreased than before,but were larger than control group(P<0.05),the range of renal capsuleperipheral vascular was increased after treatment.In DN1-B,DN2-B andDN3(A, B) groups,the distance(D)were larger than control group (P <0.05),but there were no changes before and after treatment.3The Changes of renal artery's hemodynamic before and after treatment inDN groups3.1Compared kidney hemodynamic parameters in DN groups beforetreatmentCompared with control group,the V min of IRA was markedly decreased in DN2group(P<0.05) and the RI of IRA was significantly increased (P<0.05).In DN3group,the V min of MRA and SRA was greatly lower than that ofcontrol group and the RI of them was significantly higher than that of controlgroup (P<0.05), the V max and V min of IRA were significantly lower thanthat of control group and the RI of it was significantly higher than that ofcontrol group (P<0.05).3.2Compared renal hemodynamic parameters in DN groups before and aftertreatment.3.2.1Compared the V max of renal artery before and after treatment in DNgroupsIn DN1(A,B),DN2(A,B) groups,the V max of MRA,SRA,IRA had nochanges before and after treatment;compared with control group,no changeswere observed.In DN3(A,B) groups, the V max of IRA was lower thancontrol group(p<0.05),there were no changes before and after treatment.3.2.2Compared V min of renal artery before and after treatment in DN groupsIn DN1(A,B) groups,the V min of MRA,SRA,IRA had no changes beforeand after treatment；compared with control group,no changes were observed.The V min of IRA in DN2-A group was lower than control group but higherthan that of before treatment(p<0.05). The V min of IRA in DN2-B group waslower than control group,there was no difference than that of beforetreatment.the V min of MRA,SRA,IRA in DN3(A,B) groups were lower thancontrol group (p <0.05),there was no difference before and after treatment.3.2.3Compared RI of renal artery before and after treatment in DN groups.the RI of MRA,SRA,IRA had no changes before and after treatment;compared with control group,no changes were observed. In DN2-A group,theRI of MRA, SRA, IRA were higher than that of control group, but weredecreased than that of before treatment (p <0.05). In DN2-B, DN3(A,B)groups,the RI of MRA, SRA, IRA were higher than that of control group (p <0.05), there were no changes observed before and after treatment.4Evaluated diabetic nephropathy patients by VTQ and pathology20cases of diabetic nephropathy patients who came from nephropathy department(eight cases of patients underwent Renal biopsy) were includedThis Study Showed that there were obviously difference among DN1,DN2andDN3groups；By observing the change of renal pathological in eight cases ofdiabetic nephropathy patients we found that Along with pathological damaged,Vs was getting lower and lower.5The clinical biochemical indicators to the influence of diabetic nephropathySome biochemical indicators standard-ed treatment,can control theprogress of DN.such as FPG,SBP,DBP,LDL-C,TG,Upro,Cr.Conclusion1Diabetic patients with kidney volume increased indicated the occurrenceof early nephropathy, if the change of volume was found by ultrasound,we should alert clinical doctors in time.2Combined CDFI and CDE can be used in evaluating renal perfusion,inaddition early detection of blood vessels can be found in time,it may be aconvenient examination in early diagnosis and prediction of the early stageof renal damage.3the change of renal hemodynamic parameters between DN groups withcontrol group were significantly different, The more severe the disease,the difference is more obviously.4With the progression of diabetic nephropathy,kidney elasticity is gettingworse and worse.Along with pathological damaged, Vs was gettinglower and lower.5Biochemical indicators were closely related to the progress of DN. |
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