^(99m)Tc-DTPA肾动态显像检测肾小球滤过率的临床应用评价  

Evaluation of the application of ^(99m)Tc-DTPA renography (Gates method) in the determination of glomerular filtration rate in clinical practice

作　　者：杜晓英[1] 李林法[2] 何强[1] 吴东波[1] 陈江华[1] 

机构地区：[1]浙江大学附属第一医院肾脏病中心,杭州310003 [2]浙江大学附属第一医院核医学科,杭州310003

出　　处：《中华肾脏病杂志》2006年第5期266-270,共5页Chinese Journal of Nephrology

摘　　要：目的以99mTc-DTPA血浆清除率为标准,评价99mTc-DTPA肾动态显像检查在检测肾小球滤过率(GFR)中的应用价值。方法选择慢性肾脏病患者197例,年龄均>18岁,诊断均符合美国NKF-K／DOQI关于慢性肾脏病定义。排除肾功能急性恶化因素、水肿、肢体缺如、心功能不全。记录身高、体重。肘静脉“弹丸”式注射99mTc-DTPA 111 MBq后即刻行肾动态图像采集 120帧,计算双肾GFR,即Gates法,同时于注射后2、4 h各抽血4 ml,分离血浆1 ml,测量其放射性计数,计算99mTc-DTPA的血浆清除率(双血浆法),所测数值均用体表面积标准化。按双血浆法所测得的GFR值将患者分成3组:A组77例,GFR<30 ml·min-1·(1．73 m2)-1;B组74例, 30 ml·min-1·(1．73 m2)-1≤GFR<90 ml·min-1·(1．73 m2)-1;C组46例,GFR≥90 ml·min-1·(1．73 m2)-1。分别行肾动态显像法与双血浆法所测值之间的相关分析。结果肾动态显像法及双血浆法所测3组GFR[单位:ml·min-1·(1．73 m2)-1]分别为:A组(27．08±12．14)比(17．68±5．66);B组 (63．18±23．59)比(51．95±16．81);C组(107．28±27．36)比(117．96±24．17)。2者间的相关系数分别为rA=0．286(P=0．012);rB=0．804(P<0．01);rC=0．473(P<0．01)。结论 99mTc-DTPA肾动态显像检查适用于轻、中度肾功能不全患者GFR的评估,但在重度肾功能不全患者中,其测量结果的准确性有待进一步提高。Objective To evaluate the application of ^99mTc-DTPA renography in the determination of GFR. Methods One hundred and ninety-seven patients with primary or secondary chronic kidney disease participated in this study. A 3 mci（111 MBq）/0.5 ml dose of ^99mTc-DTPA was injected as a bolus in an antecubital vein. Renal scintigraphic images were collected immediately and the images were processed according to standard procedure （Gates method）to obtain GFR. Four ml of blood was withdrawn 2 h and 4 h postinjection respectively and radioactivity of 1 ml plasma was measured. GFR was calculated by the formula of two-sample method. The results by two methods were all standardized with the body surface. The patients were divided into three subgroups according to the GFR obtained by two-sample method and the correlation between two methods was analysed respectively. Results The GFR[ml·min^-1· （1.73 m^2） ^-1]obtained from Gates method and two-sample method was displayed as follows：group A： 27.08±12.14 vs. 17.68±5.66; group B： 63.18±23.59 vs. 51.95±16.81; group C： 107.28±27.36 vs. 117.96±24.17. The correlation coefficients of three subgroups were as follows： rA=0.286（P = 0.012）; rB=0.804（P 〈 0.01）; rC=0.473（P 〈 0.01）. Conclusion Gates method is acceptable for evaluating the GFR in patients with normal to moderately diminished renal function, but it is less precise in those with severe renal insufficiency.

关 键 词：肾疾病 肾小球滤过率 99M锝五乙酸盐 肾动态显像 

分 类 号：R817.4[医药卫生—影像医学与核医学]