血氧水平依赖磁共振成像评估早期慢性肾病肾缺氧的研究

doi:10.16150/j.1671-2870.2022.03.016

摘要/Abstract

摘要：

目的：探讨肾脏血氧水平依赖（blood oxygen level-dependent,BOLD）磁共振成像（magnetic resonance imaging,MRI）评估慢性肾病（chronic kidney disease, CKD）早期肾缺氧的价值。方法：52例CKD患者（CKD组）和年龄、性别匹配的52名健康体检者（对照组）接受冠状面BOLD-MRI检查,分别测量肾脏皮、髓质R2*值。同时检测CKD患者的血清肌酐水平,运用Cockcroft-Gault公式计算获得估算肾小球滤过率,按照美国肾脏病基金会公布的肾脏病生存质量指导指南将CKD患者分为1~5期。比较对照组与CKD组、各CKD分期亚组间的肾脏皮质、髓质R2*值间的差异。结果：CKD组及对照组肾脏的髓质R2*值明显高于皮质R2*值（P<0.05）。CKD组[（16.40±2.47）/s]及CKD 1期组[（16.55±2.12）/s]、CKD 4期组[（16.48±2.95）/s]、CKD 5期组[（13.99±2.21）/s]的肾髓质R2*值均低于对照组[（18.17±2.38）/s]（P<0.05）。结论：肾脏BOLD-MRI检查可发现CKD 1期患者肾髓质R2*值的下降变化,提示BOLD成像对慢性肾病早期肾髓质缺氧变化敏感,可用于CKD早期肾功能损害的诊断。

关键词: 慢性肾病, 血氧水平依赖磁共振成像, R2*值, 缺氧

Abstract:

Objective: To evaluate value of blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) for early renal hypoxia assessment in chronic kidney disease(CKD). Methods: Fifty-two patients with CKD and 52 age- and sex-matched health volunteers underwent BOLD MRI of the kidneys. Serum creatinine (sCr) levels and estimated GFR (eGFR) were collected. The patients were classified into 5 stages according to the National Kidney Foundation′s Kidney Disease Outcomes Quality Initiative. Difference in R2*s were compared between patients and volunteers and among different stages of CKD. Results: In patients with CKD and volunteers, R2* of renal medulla was higher than that of renal cortex (P<0.05). Compared with those of volunteers, medulla R2*s in patients with CKD were significantly lower [(16.40 ± 2.47)/s vs (18.17± 2.38)/s, P<0.05]. There were no differences in cortical R2*s among CKD stages and volunteers (P>0.05). However, medullar R2*s were lower in patients with CKD1 [(16.55 ± 2.12)/s], CKD4 [(16.48 ± 2.95)/s], or CKD5 [(13.99 ± 2.21)/s] than those in volunteers [(18.17± 2.38)/s] (P<0.05). Conclusions: BOLD MRI is sensitive to renal medullary hypoxia, and which is helpful for diagnosing early stage of CKD.

Key words: Chronic kidney disease, Blood oxygen level-dependent magnetic resonance imaging, Hypoxia

中图分类号:

R692

黄娟, 朱晓雷, 李晓, 陈克敏, 严福华, 徐学勤. 血氧水平依赖磁共振成像评估早期慢性肾病肾缺氧的研究[J]. 诊断学理论与实践, 2022, 21(03): 385-389.

HUANG Juan, ZHU Xiaolei, LI Xiao, CHEN Kemin, YAN Fuhua, XU Xueqin. Study on blood oxygen level-dependent magnetic resonance imaging for the assessment of early renal hypoxia in chronic kidney disease[J]. Journal of Diagnostics Concepts & Practice, 2022, 21(03): 385-389.

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参考文献 24

[1]	Ene-Iordache B, Perico N, Bikbov B, et al. Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): a cross-sectional study[J]. Lancet Glob Health, 2016, 4(5):e307-e319.
[2]	Niendorf T, Pohlmann A, Arakelyan K, et al. How bold is blood oxygenation level-dependent (BOLD) magnetic reso-nance imaging of the kidney? Opportunities, challenges and future directions[J]. Acta Physiol (Oxf), 2015, 213(1):19-38. doi: 10.1111/apha.12393 pmid: 25204811
[3]	Fine LG, Norman JT. Chronic hypoxia as a mechanism of progression of chronic kidney diseases: from hypothesis to novel therapeutics[J]. Kidney Int, 2008, 74(7):867-872. doi: 10.1038/ki.2008.350 URL
[4]	Michaely HJ, Metzger L, Haneder S, et al. Renal BOLD-MRI does not reflect renal function in chronic kidney disease[J]. Kidney Int, 2012, 81(7):684-689. doi: 10.1038/ki.2011.455 pmid: 22237750
[5]	Yin WJ, Liu F, Li XM, et al. Noninvasive evaluation of renal oxygenation in diabetic nephropathy by BOLD-MRI[J]. Eur J Radiol, 2012, 81(7):1426-1431. doi: 10.1016/j.ejrad.2011.03.045 URL
[6]	Inoue T, Kozawa E, Okada H, et al. Noninvasive evaluation of kidney hypoxia and fibrosis using magnetic resonance imaging[J]. J Am Soc Nephrol, 2011, 22(8):1429-1434. doi: 10.1681/ASN.2010111143 URL
[7]	Khatir DS, Pedersen M, Jespersen B, et al. Evaluation of renal blood flow and oxygenation in CKD using magnetic resonance imaging[J]. Am J Kidney Dis, 2015, 66(3):402-411. doi: 10.1053/j.ajkd.2014.11.022 pmid: 25618188
[8]	National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification[J]. Am J Kidney Dis, 2002, 39(2 Suppl 1):S1-266.
[9]	Li LP, Halter S, Prasad PV. Blood oxygen level-dependent MR imaging of the kidneys[J]. Magn Reson Imaging Clin N Am, 2008, 16(4):613-625, viii. doi: 10.1016/j.mric.2008.07.008 URL
[10]	Zhang R, Wang Y, Chen F, et al. Noninvasive evaluation of renal oxygenation in primary nephrotic syndrome with blood oxygen level dependent magnetic resonance ima-ging: Initial experience[J]. J Int Med Res, 2015, 43(3):356-363. doi: 10.1177/0300060515579117 pmid: 25947644
[11]	Piskunowicz M, Hofmann L, Zuercher E, et al. A new technique with high reproducibility to estimate renal oxygenation using BOLD-MRI in chronic kidney disease[J]. Magn Reson Imaging, 2015, 33(3):253-261. doi: 10.1016/j.mri.2014.12.002 pmid: 25523609
[12]	Khatir DS, Pedersen M, Jespersen B, et al. Reproducibi-lity of MRI renal artery blood flow and BOLD measurements in patients with chronic kidney disease and healthy controls[J]. J Magn Reson Imaging, 2014, 40(5):1091-1098. doi: 10.1002/jmri.24446 pmid: 24470349
[13]	Li X, Xu X, Zhang Q, et al. Diffusion weighted imaging and blood oxygen level-dependent MR imaging of kidneys in patients with lupus nephritis[J]. J Transl Med, 2014, 12:295. doi: 10.1186/s12967-014-0295-x URL
[14]	Thoeny HC, Zumstein D, Simon-Zoula S, et al. Functio-nal evaluation of transplanted kidneys with diffusion-weighted and BOLD MR imaging: initial experience[J]. Radiology, 2006, 241(3):812-821. doi: 10.1148/radiol.2413060103 URL
[15]	Luo F, Liao Y, Cui K, et al. Noninvasive evaluation of renal oxygenation in children with chronic kidney disease using blood-oxygen-level-dependent magnetic resonance imaging[J]. Pediatr Radiol, 2020, 50(6):848-854. doi: 10.1007/s00247-020-04630-3 URL
[16]	Kang DH, Kanellis J, Hugo C, et al. Role of the microvascular endothelium in progressive renal disease[J]. J Am Soc Nephrol, 2002, 13(3):806-816. doi: 10.1681/ASN.V133806 URL
[17]	Prasad PV. Evaluation of intra-renal oxygenation by BOLD MRI[J]. Nephron Clin Pract, 2006, 103(2):c58-c65.
[18]	Eckardt KU, Bernhardt WM, Weidemann A, et al. Role of hypoxia in the pathogenesis of renal disease[J]. Kidney Int Suppl, 2005(99):S46-S51.
[19]	Nangaku M. Hypoxia and tubulointerstitial injury: a final common pathway to end-stage renal failure[J]. Nephron Exp Nephrol, 2004, 98(1):e8-e12.
[20]	Nangaku M. Chronic hypoxia and tubulointerstitial injury: a final common pathway to end-stage renal failure[J]. J Am Soc Nephrol, 2006, 17(1):17-25. doi: 10.1681/ASN.2005070757 URL
[21]	Rossi C, Artunc F, Martirosian P, et al. Histogram analysis of renal arterial spin labeling perfusion data reveals differences between volunteers and patients with mild chronic kidney disease[J]. Invest Radiol, 2012, 47(8):490-496. doi: 10.1097/RLI.0b013e318257063a URL
[22]	Gloviczki ML, Glockner JF, Crane JA, et al. Blood oxygen level-dependent magnetic resonance imaging identifies cortical hypoxia in severe renovascular disease[J]. Hypertension, 2011, 58(6):1066-1072. doi: 10.1161/HYPERTENSIONAHA.111.171405 pmid: 22042812
[23]	Neugarten J. Renal BOLD-MRI and assessment for renal hypoxia[J]. Kidney Int, 2012, 81(7):613-614. doi: 10.1038/ki.2011.462 pmid: 22419042
[24]	Pei XL, Xie JX, Liu JY, et al. A preliminary study of blood-oxygen-level-dependent MRI in patients with chro-nic kidney disease[J]. Magn Reson Imaging, 2012, 30(3):330-335. doi: 10.1016/j.mri.2011.10.003 URL

R2*值	对照组			CKD组
R2*值	左肾	右肾	P值	左肾	右肾	P值
肾皮质	12.60±1.47	12.77±1.09	0.501	12.67±2.27	13.07±2.14	0.363
肾髓质	18.31±2.88	17.96±2.45	0.509	16.21±2.42	16.59±3.00	0.466

分组	肾皮质R2*值	肾髓质R2*值	P值
对照组（n=52）	12.69±1.09	18.17±2.38	<0.001
CKD组（n=52）	12.91±2.06	16.40±2.47	<0.001
CKD 1期（n=13）	12.47±1.57	16.55±2.12	<0.001
CKD 2期（n=11）	12.89±2.30	17.38±2.51	<0.001
CKD 3期（n=10）	13.80±2.67	16.91±1.78	0.001
CKD 4期（n=9）	13.37±1.69	16.48±2.95	0.017
CKD 5期（n=9）	12.81±2.66	13.99±2.21	0.354

指标	肾皮质R2*值		肾髓质R2*值
指标	r值	P值	r值	P值
eGFR	-0.120	0.413	0.151	0.312
sCr	0.227	0.117	-0.268	0.069