■糖尿病肾病(DKD)临床轨迹的多样性使血液和生化尿液标志物的准确性降低,而肾穿刺,黄金标准,在糖尿病肾病的评估中几乎是不可能的,功能磁共振成像在糖尿病病理改变评估中的价值日益得到认可。
■在PubMed,WebofScience,科克伦图书馆,和Embase数据库。搜索时间限制是从数据库创建到2023年3月10日。使用RevMan对从DKD患者和健康志愿者(HV)中提取的fMRI的主要参数进行荟萃分析。
■本研究包括24篇出版物(1550名受试者),使用具有七个不同参数的五个功能MRI。DKD组动脉自旋标记磁共振成像(ASL-MRI)的肾血流量(RBF)值显着低于HV组。[WMD=-99.03,95%CI(-135.8,-62.27),P<0.00001];扩散张量成像磁共振成像(DTI-MRI)显示,DKD组的各向异性分数(FA)值明显低于HV组[WMD=-0.02,95CI(-0.03,-0.01),P<0.0001]。血氧水平依赖性磁共振成像(BOLD-MRI)或内体素非相干运动磁共振成像(IVIM-DWI)的相关参数差异无统计学意义。
■ASL和DWI可以识别DKD和HV之间的差异。DTI在评估肾皮质变化方面具有显着的优势;IVIM在确定皮质或髓质的早期糖尿病肾病方面具有一定的价值。我们建议结合多个功能磁共振成像参数来评估肾脏的结构或功能变化,以使评估更加全面。在本研究中,我们没有观察到明显的偏倚风险。
■https://www.crd.约克。AC.英国,标识符CRD42023409249。
The diversity of clinical trajectories in diabetic kidney disease (
DKD) has made blood and biochemical urine markers less precise, while renal puncture, the gold standard, is almost impossible in the assessment of diabetic kidney disease, and the value of functional magnetic resonance imaging in the evaluation of diabetic pathological alterations is increasingly recognized.
The literature on functional magnetic resonance imaging (fMRI) for the assessment of renal alterations in diabetic kidney disease was searched in PubMed, Web of Science, Cochrane Library, and Embase databases. The search time limit is from database creation to March 10, 2023. RevMan was used to perform a meta-analysis of the main parameters of fMRIs extracted from
DKD patients and healthy volunteers (HV).
24 publications (1550 subjects) were included in this study, using five functional MRIs with seven different parameters. The renal blood flow (RBF) values on Arterial spin labeling magnetic resonance imaging (ASL-MRI) was significantly lower in the
DKD group than in the HV group. The [WMD=-99.03, 95% CI (-135.8,-62.27), P<0.00001]; Diffusion tensor imaging magnetic resonance imaging (DTI-MRI) showed that the fractional anisotropy (FA) values in the
DKD group were significantly lower than that in HV group [WMD=-0.02, 95%CI (-0.03,-0.01), P<0.0001]. And there were no statistically significant differences in the relevant parameters in Blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI) or Intro-voxel incoherent movement magnetic resonance imaging (IVIM-DWI).
ASL and DWI can identify the differences between
DKD and HV. DTI has a significant advantage in assessing renal cortical changes; IVIM has some value in determining early diabetic kidney disease from the cortex or medulla. We recommend combining multiple fMRI parameters to assess structural or functional changes in the kidney to make the assessment more comprehensive. We did not observe a significant risk of bias in the present study.
https://www.crd.york.ac.uk, identifier CRD42023409249.