^(99)Tc^m-DMSA肾显像在小儿泌尿道感染中的应用  

The clinical application of ^(99)Tc^m-DMSA renal cortical scintigraphy in children with urinary tract infection

作　　者：赵瑞芳[1] 曾纪骅[1] 徐虹[1] 季志英[1] 袁虹[1] 

机构地区：[1]复旦大学附属儿科医院核医学科,上海200032

出　　处：《中华核医学杂志》2002年第2期99-101,共3页Chinese Journal of Nuclear Medicine

摘　　要：目的　探讨99Tcm 二巯基丁二酸 (DMSA)肾显像对鉴别小儿上、下尿路感染 (UTI)、判断肾瘢痕和指导临床治疗的价值。方法　对近 5年来临床诊断UTI2 5 2例患儿99Tcm DMSA肾显像结果进行分析。其中男 94例 ,女 15 8例 ,年龄 1个月～ 14岁。肾显像采用常规方法 ,并计算分肾功能。显像结果分为正常 [诊断为下尿路感染 (LUTI) ]和异常 [诊断为上尿路感染 (UUTI)或肾瘢痕 ]。结果　2 5 2例UTI患儿 ,110例显像正常 ,诊断为LUTI;142例显像结果异常 ,诊断为UUTI,其中 116例为急性肾盂肾炎 (APN) ,2 6例为肾瘢痕。LUTI者分肾功能为 46 %～ 5 4%。UUTI者单肾受累患者中 ,其受累肾脏分肾功能均低于 45 % (13%～ 44 % )。UUTI患儿中有 17例经正规抗感染治疗后再次显像 ,其中13例APN患儿 ,12例 6个月后随访 ,显像结果均转正常或明显好转 ,1例 4个月后随访无明显变化 ;4例肾瘢痕形成者 6个月后复查无明显变化。结论　99Tcm DMSA肾显像鉴别小儿UTI无创伤 ,简便易行 ,可靠 。Objective To study the value of 99Tc m-dimercaptosuccinic acid (DMSA) renal cortical scintigraphy in distinguishing between upper urinary tract infection (UUTI) and lower UTI (LUTI), determining renal scarring, and following-up curative effect for UTI in children. Methods We reviewed 252 results of 99Tc m-DMSA renal cortical scintigraphy in children with UTIs during a period of the past five years. The age of the patients was from 1 month to 14 years. The ratio of males∶females was 94∶158. A standard 99Tc m-DMSA renal cortical scintigraphic protocol was used. The studies were scored as normal (indicating LUTI) and abnormal (indicating acute pyelonephritis or renal scarring). And differential function of renal was calculated. Results Of 252 children with UTI, 110 cases had normal images diagnosed as with LUTI. 142 cases had abnormal images, 116 cases were diagnosed as with acute pyelonephritis, 26 cases were diagnosed as with renal cortical scars. The differential function range of LUTI was 46%～54%. Of UUTIs, the differential function of single renal involved was less than 45%. Of 142 UUTIs, 17 cases repeatedly underwent renal cortical scan after therapy. 12 of 13 cases with acute pyelonephritis completely recovered normal or obviously ameliorated after 6 months, 1 case did not show any change after 4 months. Four cases were found with renal scarring, and showed little change on repeated images for the following 6 months. Conclusions 99Tc m-DMSA renal cortical scintigraphy is of valuable significance in distinguishing between upper and lower UTI, and in estimating renal scarring. The sequelae of renal infection can be monitored by renal cortical scan. A follow-up of 6 months may be recommended after therapy.

关 键 词：^99Tc^m-DMSA肾显像 泌尿道感染 儿童 放射性核素显像 二巯基琥珀酸 

分 类 号：R817[医药卫生—影像医学与核医学]