1 徳島大学病院超音波センターUltrasound Examination Center, Tokushima University Hospital, Tokushima
2 徳島大学病院循環器内科Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima
目的：糖尿病性腎症の各病期における超音波像を比較し，病期を最も反映する腎臓の超音波検査指標を検討すること．
対象と方法：対象は臨床的に2型糖尿病と診断され，当院で腹部超音波検査を施行した57例（男性39例，女性18例，平均年齢60歳（16～86歳））．糖尿病性腎症の病期分類は2013年12月に改訂された糖尿病性腎症病期分類を用いた．1期が23例，2期が16例，3期が8例，4期が10例であった．使用装置はGE社製Logiq 7で，検討した超音波検査指標は，腎サイズ，腎末梢血管抵抗，腎皮質輝度であった．腎皮質輝度は当院で開発したiPlaque®を用いて定量的に評価した．
結果と考察：腎サイズはいずれの群間においても有意差を認めなかった．腎末梢血管抵抗は1期と3期，4期および2期と4期において有意差を認め（p＜0.05），病期と腎末梢血管抵抗の間には，弱い相関を認めた（ρ＝0.472, p＜0.05）．腎皮質輝度はいずれの群間においても有意差を認め（p＜0.05），病期と腎皮質輝度の間にも，有意な相関を認めた（ρ＝0.736, p＜0.05）．尿アルブミンは，腎末梢血管抵抗および腎臓の皮質輝度と有意な相関を認め，最も相関の高い超音波検査指標は，腎皮質輝度であった（r＝0.57, p＜0.001）．eGFRは，腎臓のサイズ，腎末梢血管抵抗および皮質輝度のいずれとも有意な相関を認めたが，腎皮質輝度が最も高い相関を示した（r＝−0.59, p＜0.001）．腎皮質輝度は糖尿病性腎症において，病初期から上昇し，病期の進行に応じて上昇傾向を示すため，病期の評価に有用と考えた．
結論：糖尿病性腎症において，病期を最も反映する腎臓の超音波検査指標は腎皮質輝度であった．
Objectives: The aim of this study was to evaluate renal functional impairment in diabetic nephropathy using ultrasonographic indices of the kidney.
Subjects and Methods: We enrolled 57 patients (mean age 60±17 years, 65% male) who were clinically diagnosed with type 2 diabetes and underwent abdominal ultrasonography at our hospital. Patients were classified based on the Classification of Diabetic Nephropathy as revised in December 2013. Out of the total 57 patients, 23 were stage 1, 16 patients were stage 2, 8 patients were stage 3, and 10 patients were stage 4. We evaluated kidney size, renal peripheral vascular resistance index (RI), and renal cortical brightness using a Logiq 7 Ultrasound device (GE health care Japan). Renal cortex brightness was quantitatively evaluated using iPlaque® developed at our hospital.
Result and Discussions: There was no significant difference in kidney size between any groups. The RI was significantly different between stage 1 and 3, stage 1 and 4, and stage 2 and 4 (p＜0.05); a weak correlation was found between the stages and RI (ρ＝0.472, p＜0.05). The renal cortical brightness was significantly different between all groups (p＜0.05), and stages (ρ＝0.736, p＜0.05). Urinary albumin was significantly correlated with RI and renal cortical brightness; among them, renal cortical brightness was the most correlated (r＝0.57, p＜0.001). eGFR was significantly correlated with all of the indices, and renal cortical brightness showed the best correlation (r＝−0.59, p＜0.001). Consequently, we determined that renal cortical brightness is a useful parameter for evaluating diabetic nephropathy because it increased from the early stage and correlated with stage progression.
Conclusions: In diabetic nephropathy, renal cortical brightness is the most useful index to reflect the disease stage.
Key words: diabetic nephropathy; renal cortex; echogenicity; integrated backscatter
© 2019 一般社団法人日本超音波検査学会© 2019 Japanese Society of Sonographers
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This page was last modified on 2019-08-02T13:05:26.000+09:00
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