BOLD联合mDixon Quant定量评估2型糖尿病患者早期肾脏氧代谢和铁沉积的效果

doi:10.11958/20251550

天津医药 ›› 2025, Vol. 53 ›› Issue (11): 1197-1203.doi: 10.11958/20251550

BOLD联合mDixon Quant定量评估2型糖尿病患者早期肾脏氧代谢和铁沉积的效果

任宇¹(), 李慧宇², 马亚杰³, 张钰玲⁴, 季倩^4△()

¹ 天津中医药大学医学技术学院（邮编 301617 ）
² 天津医科大学第一中心医院
³ 江苏省苏北人民医院放射科
⁴ 天津市第一中心医院放射科，天津市影像医学研究所

收稿日期:2025-04-22 修回日期:2025-08-24 出版日期:2025-11-15 发布日期:2025-11-19
通讯作者: △E-mail：jiqianq@aliyun.com
作者简介:任宇（1995），男，硕士研究生在读，主要从事医学影像技术方面研究。E-mail：18135435327@163.com
基金资助:
天津市医学重点学科（专科）建设项目(TJYXZDXK-041A);天津市自然科学基金(21JCYBJC01050)

The effect of BOLD combined with mDixon Quant in quantitatively evaluating the early renal oxygen metabolism and iron deposition in patients with type 2 diabetes

REN Yu¹(), LI Huiyu², MA Yajie³, ZHANG Yuling⁴, JI Qian^4△()

¹ The Medical Technology School, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
² First Central Hospital of Tianjin Medical University
³ Department of Radiology, Jiangsu Provincial Northern Jiangsu People's Hospital
⁴ Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine

Received:2025-04-22 Revised:2025-08-24 Published:2025-11-15 Online:2025-11-19
Contact: △E-mail：jiqianq@aliyun.com

任宇, 李慧宇, 马亚杰, 张钰玲, 季倩. BOLD联合mDixon Quant定量评估2型糖尿病患者早期肾脏氧代谢和铁沉积的效果[J]. 天津医药, 2025, 53(11): 1197-1203.

REN Yu, LI Huiyu, MA Yajie, ZHANG Yuling, JI Qian. The effect of BOLD combined with mDixon Quant in quantitatively evaluating the early renal oxygen metabolism and iron deposition in patients with type 2 diabetes[J]. Tianjin Medical Journal, 2025, 53(11): 1197-1203.

摘要/Abstract

摘要：

目的探讨血氧水平依赖（BOLD）联合mDixon Quant定量评估2型糖尿病（T2DM）患者早期肾脏氧代谢和铁沉积的效果。方法前瞻性收集2022年9月—2023年12月天津市第一中心医院58例T2DM患者资料，根据尿白蛋白/肌酐比值（ACR）分成正常白蛋白尿（NAU，ACR<30 mg/g）组35例和微量白蛋白尿（MAU，30 mg/g≤ACR<300 mg/g）组23例。同期纳入33例健康志愿者作为对照组。所有受试者行腹部BOLD及mDixon Quant序列扫描，测量肾皮质、髓质表观弛豫率（R2^*）。比较各组间一般资料及影像学参数值的差异，应用受试者工作特征（ROC）曲线分析相关参数对早期肾功能改变的诊断效能。结果对照组、NAU组和MAU组体质量、估算的肾小球滤过率（eGFR）、ACR差异有统计学意义（P<0.01）。同组内肾皮质R2^*值均低于肾髓质R2^*值（P<0.01）。3组间除BOLD肾皮质R2^*值差异无统计学意义外，其余参数差异均有统计学意义（P<0.05）。区分对照组与NAU组、NAU组与MAU组、对照组与T2DM早期（NAU+MAU）时，两序列联合的曲线下面积（AUC）均高于任何单一序列，其AUC值分别为0.892（95%CI：0.809~0.975）、0.785（95%CI：0.666~0.904）和0.841（95%CI：0.756~0.926）。结论 BOLD联合mDixon Quant能够无创、定量评估T2DM患者早期肾脏氧代谢及铁含量变化情况，两序列联合的诊断效能更优。

关键词: 糖尿病, 2型, 白蛋白尿, 血氧水平依赖, mDixon Quant, 肾功能, 氧代谢, 铁沉积

Abstract:

Objective To assess renal oxygen metabolism and iron deposition in type 2 diabetes mellitus (T2DM) patients using a combination of blood oxygen level-dependent (BOLD) and mDixon Quant techniques. Methods Clinical data of 58 T2DM patients from Tianjin First Central Hospital (September 2022-December 2023) were prospectively collected. According to urinary albumin-to-creation ratio (ACR), patients were divided into the normal albuminuria (NAU, ACR<30 mg/g, n=35) group and the microalbuminuria (MAU, 30 mg/g≤ACR<300 mg/g, n=23) group. Thirty-three healthy volunteers were included as the control group during the same period. All participants underwent renal BOLD and mDixon Quant MRI to obtain cortical and medullary apparent relaxation rate (R2^*) values. The differences of general data and image parameter values were compared between groups. Receiver operating characteristic (ROC) curves were used to analyze the diagnostic efficacy of relevant parameters for early renal function changes. Results There were significant differences in body weight, estimated glomerular filtration rate (eGFR) and ACR between the control group, the NAU group and the MAU group (P<0.01). The R2^* value in renal cortex was lower than that in renal medulla (P<0.01) in the same group. Apart from R2^* value of BOLD renal cortex, which showed no significant difference between the three groups (P<0.05)，and the differences in the other parameters were statistically significant (P < 0.05). When distinguishing between the control group and the NAU group, the NAU group and the MAU group, as well as between the control group and the early-stage T2DM (NAU+MAU) group, the combined two-sequence approach demonstrated higher area under the curve (AUCs) than any single sequence alone, with AUC value of 0.892 (95%CI: 0.809-0.975), 0.785 (95%CI: 0.666-0.904) and 0.841 (95%CI: 0.756-0.926), respectively. Conclusion The combination of BOLD imaging with mDixon Quant enables noninvasive and quantitative assessment of alterations in renal oxygen metabolism and iron content in early-stage T2DM patients. The diagnostic performance of this combined approach surpasses that of individual methods.

Key words: diabetes mellitus, type 2, albuminuria, blood oxygenation level dependent, mDixon Quant, renal oxygenation, oxygen metabolism, iron deposition

中图分类号:

R445.2

图/表 8

参考文献 21

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组别	n	年龄/岁		男性	身高/m
对照组	33	46.24±11.53		20（60.6）	1.69±0.08
NAU组	35	45.33±11.55		24（68.6）	1.92±0.10
MAU组	23	48.52±12.04		16（69.6）	1.70±0.72
F或$\chi $²		0.533		0.660	0.858
组别	体质量/kg		eGFR/ [mL/（min·1.73m²）]		ACR/（mg/g）
对照组	68.22±11.71		108.55±13.29		15.86±2.17
NAU组	85.14±14.42^a		121.93±24.73^a		13.42±7.13
MAU组	81.55±16.76^a		95.61±27.86^ab		139.77±89.81^ab
$\chi $²	13.029^＊＊		9.902^＊＊		66.091^＊＊

组别	n	年龄/岁		男性	身高/m
对照组	33	46.24±11.53		20（60.6）	1.69±0.08
NAU组	35	45.33±11.55		24（68.6）	1.92±0.10
MAU组	23	48.52±12.04		16（69.6）	1.70±0.72
F或$\chi $²		0.533		0.660	0.858
组别	体质量/kg		eGFR/ [mL/（min·1.73m²）]		ACR/（mg/g）
对照组	68.22±11.71		108.55±13.29		15.86±2.17
NAU组	85.14±14.42^a		121.93±24.73^a		13.42±7.13
MAU组	81.55±16.76^a		95.61±27.86^ab		139.77±89.81^ab
$\chi $²	13.029^＊＊		9.902^＊＊		66.091^＊＊

组别	n	BOLD
组别	n	肾皮质R2^*	肾髓质R2^*	t
对照组	33	18.54±1.39	28.37±1.44	25.399^＊＊
NAU组	35	17.42±1.95	32.28±3.30^a	22.169^＊＊
MAU组	23	17.92±2.46	29.33±2.05^b	23.853^＊＊
F		2.935	23.172^＊＊
组别	mDixon Quant
组别	肾皮质R2^*		肾髓质R2^*	t
对照组	18.23±1.09		28.04±2.29	20.945^＊＊
NAU组	17.15±1.90^a		32.12±3.45^a	22.657^＊＊
MAU组	17.55±1.52		29.35±1.41^b	26.143^＊＊
F	4.117^＊		20.979^＊＊

组别	n	BOLD
组别	n	肾皮质R2^*	肾髓质R2^*	t
对照组	33	18.54±1.39	28.37±1.44	25.399^＊＊
NAU组	35	17.42±1.95	32.28±3.30^a	22.169^＊＊
MAU组	23	17.92±2.46	29.33±2.05^b	23.853^＊＊
F		2.935	23.172^＊＊
组别	mDixon Quant
组别	肾皮质R2^*		肾髓质R2^*	t
对照组	18.23±1.09		28.04±2.29	20.945^＊＊
NAU组	17.15±1.90^a		32.12±3.45^a	22.657^＊＊
MAU组	17.55±1.52		29.35±1.41^b	26.143^＊＊
F	4.117^＊		20.979^＊＊

参数	AUC（95%CI）	截断值/Hz	敏感度/%	特异度/%	阳性预测值/%	阴性预测值/%	准确度/%
髓质BOLD R2^*	0.869（0.782~0.957）	32.6	97.0	65.7	86.9	84.2	82.4
皮质mDixon Quant R2^*	0.719（0.592~0.847）	17.0	87.9	57.1	85.2	80.3	77.9
髓质mDixon Quant R2^*	0.867（0.774~0.959）	33.3	93.9	74.3	85.5	84.6	85.3
皮质和髓质mDixon Quant R2^*	0.887（0.801~0.972）	26.3	94.3	99.9	87.8	82.9	97.1
BOLD联合mDixon Quant R2^*	0.892（0.809~0.975）	19.9	97.0	88.9	90.4	88.1	92.6

BOLD联合mDixon Quant定量评估2型糖尿病患者早期肾脏氧代谢和铁沉积的效果

The effect of BOLD combined with mDixon Quant in quantitatively evaluating the early renal oxygen metabolism and iron deposition in patients with type 2 diabetes

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参数	AUC（95%CI）	截断值/Hz	敏感度/%	特异度/%	阳性预测值/%	阴性预测值/%	准确度/%
髓质BOLD R2^*	0.778（0.657~0.898）	31.5	60.0	91.3	70.9	81.3	79.3
髓质mDixon Quant R2^*	0.773（0.652~0.894）	30.9	60.0	95.7	76.7	80.4	79.3
BOLD联合mDixon Quant R2^*	0.785（0.666~0.904）	30.2	65.7	91.3	84.4	83.8	81.0

参数	AUC（95%CI）	截断值/Hz	敏感度/%	特异度/%	阳性预测值/%	阴性预测值/%	准确度/%
髓质BOLD R2^*	0.778（0.685~0.872）	32.7	97.0	48.3	91.8	90.0	79.1
皮质mDixon Quant R2^*	0.702（0.596~0.808）	17.23	81.8	55.2	79.9	84.2	52.8
髓质mDixon Quant R2^*	0.822（0.733~0.911）	35.1	72.7	81	91.1	83.7	74.7
皮质和髓质mDixon Quant R2^*	0.834（0.749~0.919）	28.0	77.6	87.9	84.2	85.7	81.3
BOLD联合mDixon Quant R2^*	0.841（0.756~0.926）	23.2	82.8	78.8	90.1	87.7	81.4

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