肾脏深度对影像法测定肾小球滤过率的影响  

Evaluation of the Influence of Kidney Depth in GFR with Radionuclide Renal Scintigraphy

作　　者：张旭初[1] 王荣福[1] 李乾[1] 

机构地区：[1]北京大学第一医院核医学科,北京100034

出　　处：《标记免疫分析与临床》2010年第1期30-34,共5页Labeled Immunoassays and Clinical Medicine

基　　金：国家重点基础研究发展计划基金-973计划(2006CB705705);国家自然科学基金(30470498;30670583)资助;北京大学985II期基金资助(985-2-056)

摘　　要：为检测肾动态显像法中国人肾脏深度预测方程对肾小球滤过率测量的影响,选取482例慢性肾病(CKD)患者,依次用下面三种方法检测患者的肾小球滤过率(GFR):经典放射性核素动态显像法(gGFR)、校正肾脏深度的放射性核素动态显像法(v-gG-FR)和双血浆法(rGFR)。双血浆法(rGFR)测量结果为金标准,将经典放射性核素动态显像法(gGFR)和校正肾脏深度的放射性核素动态显像法(v-gGFR)与双血浆法(rGFR)进行比较。在v-gGFR法中,没有使用Gate’s方法中使用的Tonnesen方程,而是应用本课题组以前研究得到的肾脏深度方程:右肾深度(cm)=15.449×(体重/身高)+0.009637×年龄+0.782;左肾深度(cm)=16.772×(体重/身高)+0.01025×年龄+0.224(体重kg,身高cm)。用SPSS10.0进行统计,P<0.05为具有统计学意义。计量资料以均数±标准差或中位数表示。采用B land-A ltman分析法比较gGFR和v-gGFR。用spearman相关和线性回归分析gGFR、v-gGFR和rGFR测量值的关系。结果显示,gGFR测量值和v-gGFR测量值均与rGFR测量值相关性良好(r=0.75,P<0.001;r=0.81,P<0.001)。v-gGFR和rGFR测量值的偏差小于gGFR和rGFR测量值的偏差。gGFR的测量值落在rGFR测量值±15%、±30%和±50%范围内的病例百分数分别为32.4%、45.0%、56.0%;v-gGFR的测量值落在rGFR测量值±15%、±30%和±50%范围内的病例百分数分别为74.5%、79.1%、89.9%。这项研究说明,v-gGFR测量值准确性优于gGFR。To evaluate the effect of kidney depth in calculating GFR with radionuclide renal scintigraphy,482 patients with chronic kidney disease（CKD） were selected.GFR were estimated simultaneously using three methods： modified Gate＇s method（gGFR）;Gate＇s method with the verify formulae of depth（v-gGFR）;dual plasma sampling method（rGFR）.Using rGFR as the reference method,gGFR and v-gGFR were compared with rGFR.In v-gGFR,instead of Tonnesen＇s formula,which was used to estimate the renal depth in Gate＇s method,we adopted the renal depth formula obtained in our previous study： right kidney depth（cm）=15.449×（weight/height）＋0.009637×age＋0.782;left kidney depth（cm）=16.772×（weight/height）＋0.01025×age＋0.224（weight,kg;height,cm）.All statistics were performed using SPSS 10.0 and P〈0.05 indicates statistical significance.Quantitative variables were described as x^-±s or median.The estimated gGFR and v-gGFR were compared using Bland-Altman analysis.The spearman correlation and linear regression were used to describe the relationship between gGFR/v-gGFR and rGFR.The results showed that both gGFR and v-gGFR were correlated well with rGFR（r=0.75,P〈0.001;r=0.81,P〈0.001）.The difference and absolute difference between v-gGFR and rGFR were siginificantly less than those between gGFR and rGFR.For gGFR,the 15%,30% and 50% accuracies were 32.4%,56.0% and 79.1%,respectively;for v-gGFR,the corresponding accuracy rose to 45.0%,74.5% and 89.9%,respectively.In this research,the GFR was obtained by the new formula of kidney depth was more accurate than GFR estimated by tradional radionuclide renal scintigraphy.

关 键 词：肾小球滤过率 单光子发射断层计算机扫描机 肾动态显像 肾脏深度 

分 类 号：R692[医药卫生—泌尿科学] R817.4[医药卫生—外科学]