蛋白质负荷肾显像观察2型糖尿病早期肾病的肾储备功能  

Renal function reserve in patients with early type 2 diabetic nephropathy using protein loading-scintirenography

作　　者：田蓉蓉[1] 张承刚[1] 齐昊[2] 李险峰[1] 王进[1] 刘建中[1] 李思进[1] 高飞[2] 杨静[2] 

机构地区：[1]山西医科大学第一医院核医学科,太原030001 [2]山西医科大学第一医院内分泌科,太原030001

出　　处：《中华核医学杂志》2010年第3期185-188,共4页Chinese Journal of Nuclear Medicine

摘　　要：目的 用蛋白质负荷肾动态显像评价2型糖尿病（DM）早期肾病患者的肾储备功能（RFR）.方法 研究对象共50例：健康对照组（G1组）14例,2型DM正常白蛋白尿组（G2组）15例,2型DM早期肾病组（G3组）21例.1周内分别行静息及蛋白质负荷99Tcm-DTPA肾动态显像.肾储备值为负荷前后肾小球滤过率（GFR）、高峰时间、半排时间、20 min残留率的差值.采用单因素方差分析和t检验,对3组各参数进行比较.结果 GFR所得肾储备值在3组间差异均有统计学意义（t=14.884,32.180,16.042,P均＜0.01）,蛋白质负荷后,G1组GFR平均增加了20.1ml·min-·1.73 m-2,G2组平均增加了10.9 ml·min-1·1.73 m-2,G3组仅增加了2.2 ml·min-1·1.73 m-2 半排时间所得肾储备值在G2组和G1组间差异有统计学意义（t=5.505,P＜0.05）,而G3组和G1组间的差异有明显统计学意义（t=8.914,P＜0.01） 高峰时间所得肾储备值在G3组和G1组间差异也有统计学意义（t=5.690,P＜0.01） 20 min残留率所得肾储备值在G3组和G1组间差异有统计学意义（t=4.376,P＜0.05）.结论 蛋白质负荷肾动态显像是测定RFR的有效方法,RFR是评价DM早期肾损害的有效指标.Objective To explore a sensitive method and index to evaluate renal functional reserve （RFR） in patients with early diabetic nephropathy （DN） using protein loading-scintirenography.Methods Fifty subjects were studied and divided into 3 groups.Group one （G1） consisted of 14 healthy volunteers Group two （G2） consisted of 15 patients with type 2 diabetes mellitus （DM） and normoalbuminuria Group three （G3） consisted of 21 patients with type 2 DM and microalbuminuria.All subjects underwent baseline and protein loading-99 Tcm-DTPA scintirenography within one week.RFR was calculated as the difference between stimulated and baseline glomerular filtration rate （GFR）, time of peak （ Tb ）, time of half excretion （ C1/2 ）, residual rate at 20 min （ C20/b ） .Variance analysis and t-test were used to analyze the group differences.Results （ 1 ） The RFR in terms of GFR had statistical difference between any two groups （t=14.884, 32.180, 16.042, all P〈0.01）.After protein-loading, the GFR of G1, G2 and G3 increased 20.1, 10.9 and 2.2 ml·min-1·1.73 m-2 respectively.Therefore, the RFR decreased before microalbuminuria in type 2 DM patients.（2）There was statistical difference between the RFR of G1 and G2 in terms of C1/2 （t = 5.505, P〈0.05 ）, and between G1 and G3 （ t = 8.914, P〈0.01 ）.（3） There was statistical difference of the RFR in terms of TP between G1 and G3 （t = 5.690, P 〈 0.01 ）.（4） There was statistical difference of the RFR in terms of C20/b between G1 and G3 （t= 4.376, P〈0.05 ）.Conclusions 99Tcm-DTPA protein loading-scintirenography is an effective method for measuring RFR to evaluate early DN in type 2 DM patients.

关 键 词：糖尿病 非胰岛素依赖型 糖尿病肾病 放射性核素显像 DTPA 

分 类 号：R587.2[医药卫生—内分泌]