SPECT肾动态显像在肾移植中的应用  

Study of Renal Transplantation by SPECT Renal Dynamic Imaging

作　　者：徐荣[1] 付爱珍 梅海涛[1] 刘蓉[1] 

机构地区：[1]江西省人民医院核医学科 [2]江西省樟树市人民医院儿科

出　　处：《中国医学计算机成像杂志》2013年第5期451-454,共4页Chinese Computed Medical Imaging

基　　金：江西省卫生厅课题(No:046)J~~

摘　　要：目的:通过异体肾移植SPECT肾动态显像的研究,探讨对移植肾排斥反应的诊断和肾功能评价的价值。方法:以^(99m)Tc-DTPA为示踪剂,对53例异体肾移植后的患者进行^(99m)Tc-DTPA SPECT肾动态显像。结果:①稳定组:移植肾显像清晰,移植肾最大放射性计数/腹主动脉最大放射性计数(K/A)比值为4.76±0.75,25min膀胱/移植肾放射性计数(B/K)比值>1。移植肾GFR(肾小球滤过率)均值为57.7±11.95 ml/min。②排异组:早期肾影欠清晰(K/A)比值下降,肾脏排泄核素延缓,(B/K)比值<1,移植肾GFR均值减低,随着排斥反应程度的加重,(K/A)、GFR值继续下降,排斥反应特别严重时肾脏几乎不显影。③急性肾小管坏死恢复期:B/K>1,移植肾GFR、K/A值亦明显上升。结论:SPECT^(99m)Tc-DTPA肾动态显像对移植肾排异反应的诊断、抗排异反应的疗效评估及对急性肾小管坏死和排异反应鉴别诊断均有一定的临床价值。Purpose： To evaluate the value of SPECT renal dynamic imaging in diagnosis of renal rejection and assessment of renal function in patients with allograft renal transplantation. Methods： Fifty- three patients with allograft renal transplantation were undergone 99mTc-DTPA SPECT renal dynamic imaging. Results： （1） The stable groups： The visualization of transplanted kidneys was clear, and the ratio of their maximum radioactive count/abdominal aorta maximum radioactive count （K/A） was 4.76±0.75, and the ratio of 25 minutes bladder radioactive count/transplanted kidney radioactive count （B/K） was larger than 1. The mean GFR （glomerular filtration rate） of transplanted kidney was 57.7±11.95 ml/min. （2） Rejection groups： In early phase, the visualization of the transplanted kidneys was not so clear, the K/A ratio was dropped, the excretion of nuclide was delayed, the B/K ratio was less than 1, and the mean GFR was also reduced; in the later phase, the ratio of K/A, mean GFR value was decreased continuously, and the transplanted kidneys were almost not visualized. （3） Convalescence phase of acute tubular necrosis： The ratio of B/K was larger than 1, mean GFR and ratio of K/A was increased obviously. Conclusion： SPECT 99mTc-DTPA renal dynamic imaging has clinical value in the diagnosis of renal allograft rejection, evaluation of anti-rejection curative effect, and differential diagnosis of acute renal tubular necrosis and rejection reaction.

关 键 词：移植肾排异反应 SPECT显像 二乙三胺五乙酸 肾小球滤过滤 

分 类 号：R699.2[医药卫生—泌尿科学]