放射性核素肾动态显像在诊断肾移植术后早期并发症中的应用价值  

Clinical impacts of radionuclide renography in early stage renal transplantation

作　　者：贾平[1] 吴晓莉 蒋金根[3] 

机构地区：[1]浙江省人民医院肾内科,杭州310014 [2]浙江省中医学院生命科学系 [3]复旦大学附属中山医院肾内科

出　　处：《中华核医学杂志》2007年第6期370-372,共3页Chinese Journal of Nuclear Medicine

摘　　要：目的探讨放射性核素肾动态显像的半定量参数对肾移植术后早期并发症诊断与鉴别诊断的价值,并评价其对患者预后判断的意义。方法回顾性分析79例肾移植术后行放射性核素肾动态显像的患者资料,分为4组:急性排斥反应(简称急排)组18例,加速性排斥反应(简称加排)组12例、急性肾小管坏死(ATN)组29例,肾功能正常(对照)组20例,分别计算灌注相腹主动脉放射性高峰时间(A_(峰时))、移植肾放射性高峰时间(K_(峰时))、移植肾放射性高峰计数与腹主动脉高峰计数比值(K_(max)/A_(max))及1 min 计数比值(K_(1 min)/A_(1 min)),功能相移植肾20 min 计数/3 min 计数(K_(20 min)/K_(3 min))、K_(20 min)/高峰计数(K_(20 min)/Kp_(peak))、20 min 时膀胱/移植肾放射性计数比值(B/K)。分析并比较各参数尤其是 K_(max)/A_(max)和 K_(1 min)/A_(1 min)诊断与鉴别诊断。肾移植术后早期并发症的价值;对 ATN 组K_(1 min)/A_(1 min)进行分区,分析 K_(1 min)/A_(1 min)大小与患者预后之间的关系。结果各参数中,以 K_(1 min)/A_(1 min)、B/K 临床价值较大。急排、加排组 K_(1 min)/A_(1 min)分别为2.54±1.59和2.04±0.94,较对照组(9.29±1.63)明显下降(P 均<0.01),ATN 组 K_(1 min)/A_(1 min)为5.74±2.35,与急排、加排组差异有统计学意义(P 均<0.01),急排与加排组间差异无统计学意义(P>0.05)。K_(1 min)/A_(1 min)诊断 ATN 的准确性为89.7%,高于 K_(max)/A_(max)(55.2%)。K_(1 min)/A_(1 min)≥4及 B/K>1,为肾功能正常;K_(1 min)/A_(1 min)≥4及B/K<1为 ATN;K_(1 min)/A_(1 min)<4及 B/K<1为出现排斥反应。K_(1 min)/A_(1 min)与 ATN 预后及并发症间存在一定联系。结论 K_(1 min)/A_(1 min)结合 B/K 比值有助于肾移植术后早期并发症的诊断与鉴别诊断,且K_(1 min)/A_(1 min)可用于移植肾病变预后的监测。Objective The aim of this study was to investigate which parameter used in radionuclide renography would benefit in early detecting and differentiating complications after renal transplantation. Methods Seventy-nine patients who had radionuclide renography within 72 h after renal transplantation were included. Of the 79 patients, 20 were normal （control）, 18 were acute rejection （AR）, 12 were accelerated acute rejection （AAR） and 29 were acute tubular necrosis （ATN）. Factors including changes of perfusion and （or） function of the kidney allograft and outcome after AR, AAR and ATN were evaluated using the parameters of the ratio of graft maximal count in perfusion scintigraphy to that of iliac artery （ Kmax/Amax） and the ratio of graft count at 1 min to that of iliac artery （ K1min/A1min） Results Among the parameters used in this study, K1min/A1min Was significant lower in AR and AAR （2.54 ± 1.59 and 2.04 ± 0.94） than in control （9.29 ±1.63, P〈0.01） and ATN （5.74±2.35, P〈0.01） groups. The diagnostic accuracy of ATN with K1 min/A1 min was higher than with Kmax/Amax（89.7% vs 55.2% ）. Moreover, the results showed that K1 min/A1 min 〈 4 and the ratio of bladder count to that of graft at 20 min （B/K） 〈 1 suggested rejection. For those with ≥ 4, B/K 〈 1 suggested ATN and 〉 1 indicated to be normal. Conclusion Combination of parameters including K1 min/A1 min and B/K, diuretic renography would be helpful in early detecting and differentiating AR, AAR and ATN after renal transplantation.

关 键 词：肾移植 移植物排斥 肾小管坏死 急性 放射性核素显像 EC 

分 类 号：R817.4[医药卫生—影像医学与核医学]