碘海醇清除率在慢性肾脏病儿童肾功能评价方面的应用  

Application of Plasma Clearance of Iohexol in Evaluating Renal Function in Chinese Children with Chronic Kidney Disease

作　　者：王宝宝[1] 武元[1] 秦岩[1] 弓孟春[1] 石希敏[2] 景红丽[2] 李方[2] 陈朝英[3] 宋红梅[4] 李雪梅[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院肾内科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院核医学科,北京100730 [3]首都儿科研究所附属儿童医院肾内科,北京100020 [4]中国医学科学院北京协和医学院北京协和医院儿科,北京100730

出　　处：《中国医学科学院学报》2015年第2期171-178,共8页Acta Academiae Medicinae Sinicae

基　　金：北京市科学技术委员会资助项目(D131100004713007;D09050704310901)~~

摘　　要：目的评价碘海醇清除率评估慢性肾脏病儿童肾小球滤过率的准确性,评估单次采血法和干血滤纸片法在碘海醇清除率应用中的可行性。方法纳入慢性肾脏病儿童45例,同时进行锝99m-二乙烯三胺五乙酸(99mTc-DTPA)血浆清除率与碘海醇血浆清除率测定,评价两种方法测得的肾小球滤过率的相关性和一致性。分析碘海醇单次取血法及干血滤纸片法与碘海醇双次采血法的一致性。结果 45例患儿均完成碘海醇血浆清除率测定。其中36例患儿同时完成99mTcDTPA血浆清除率测定,13例患儿完成干血滤纸片碘海醇清除率测定。碘海醇血浆清除率与99mTc-DTPA血浆清除率具有较好的相关性和一致性(r=0.941,P<0.01),两者结果的差值较小,为(6.53±11.6)ml/(min·1.73 m2)。碘海醇单次取血法和干血滤纸片法测定的清除率与碘海醇双次取血血浆清除率均具有较好的相关性(r=0.958,r=0.950),差值分别为(4.26±9.06)ml/(min·1.73 m2)和(0.48±10.89)ml/(min·1.73 m2)。结论碘海醇血浆清除率是一种安全、可靠的评估慢性肾脏病儿童肾功能的方法,单次取血法与干血滤纸片法使碘海醇清除率测定更简便、可行。Objective To evaluate the accuracy of plasma clearance of iohexol（ PCio） for glomerular filtration rate（ GFR） measurement in Chinese children with chronic kidney disease（ CKD） and assess the feasibility of single-blood-sample method or dried capillary blood spots in determining the PCio. Methods Totally45 CKD children were included,in whom the99mTechnetium-diethylenetriaminepentaacetic acid（99mTc-DTPA）plasma clearance and iohexol plasma clearance were simultaneously determined. Blood samples were obtained 2,4,and 5 hours after injection. In addition,we also evaluated the efficacy of single blood sample method and dried blood spots method in iohexol plasma clearance. Results Forty-five CKD children completed the iohexol plasma clearance and thirty-six children completed the99mTc-DTPA plasma clearance at the same time among them. Thirteen children finished the iohexol dried blood spot clearance. The correlation coefficient between99 mTcDTPA plasma clearance and iohexol plasma clearance was 0. 941 and the bias was（ 6. 53 ± 11. 6） ml /（ min·1. 73 m2）,and the intraclass correlation coefficient（ ICC） was high（ ICC = 0. 947）. The correlation between iohexol single-sample plasma clearance and double samples was also strong（ r = 0. 958）,with the bias being（ 4. 26 ± 9. 06） ml /（ min·1. 73 m2） and the ICC being 0. 970. The iohexol clearance by dried blood spots showed a good correlation with the serum iohexol clearance（ r = 0. 950）,with the bias still being small [（ 0. 48 ±10. 89） ml /（ min·1. 73 m2） ]. Conclusions Iohexol plasma clearance has satisfactory agreement with99 mTcDTPA plasma clearance and can be used as an ideal method to measure GFR in CKD children. The single-sample method and dried blood spots method make iohexol plasma clearance more convenient and practical.

关 键 词：碘海醇清除率 儿童 慢性肾脏病 肾小球滤过率 

分 类 号：R692[医药卫生—泌尿科学]