99Tc^(m) -DTPA肾动态显像联合骨显像分析痛风患者肾功能受损特点  

The Combination of 99Tc^(m)-DTPA Renal Dynamic Imaging and 99Tc^(m)-MDP Bone Scan in Analyzing the Features of Renal Function of Gouty Patients

作　　者：张毓艺 张连娜[1] 冯瑾[1] 高璇 杨芳[1] ZHANG Yuyi;ZHANG Lianna;FENG Jin;GAO Xuan;YANG Fang(Department of Nuclear Medicine,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院核医学科,北京100035

出　　处：《标记免疫分析与临床》2022年第7期1164-1169,共6页Labeled Immunoassays and Clinical Medicine

摘　　要：目的将^(99)Tc^(m)-DTPA肾动态显像联合骨显像分析痛风患者肾功能受损特点并评价其对痛风肾损害的临床价值。方法回顾性分析128例痛风患者的^(99)Tc^(m)-DTPA肾动态显像,其中124例患者同期行骨显像。分析肾小球滤过率(GFR)、达峰时间(t_(p))、C_(20)等参数在不同临床分组间有无差异,采用t检验、χ^(2)检验统计学分析。结果(1)双肾总GFR及分肾GFR在年龄大于40岁、病程超过5年、血肌酐升高的患者中,均低于年龄小于40岁、病程不足5年、血肌酐正常组,差异有统计学意义(P均<0.05)。总GFR及分肾GFR在不同性别、临床分期、血尿酸、尿微量白蛋白及尿α1球蛋白组中差异无统计学意义(P均>0.05)。C_(20)减低在血肌酐及尿微量白蛋白升高组的比例分别为47%、46%,明显高于血肌酐及尿微量白蛋白正常组(17%、19%),χ^(2)分别为11.933、8.554,P值分别为0.001、0.003。t_(1/2)在各组中差异均无统计学意义(P均>0.05)。(2)肾脏有结晶或结石组分肾GFR为41.06±12.61mL/min,低于非结晶结石组45.39±10.30mL/min,t值为-2.558,P值为0.011。总肾GFR、t_(p)、t_(1/2)、C_(20)在结晶结石组与非结晶结石组中差异均无统计学意义(P均>0.05)。(3)痛风受累关节数目>3处时,分肾GFR值为41.75±11.86mL/min,低于≤3处组45.21±11.94mL/min,差异有统计学意义,t值为2.140,P值为0.033。痛风累及第一跖趾关节时,分肾GFR值为42.06±10.49mL/min,低于未累及第一跖趾关节组45.77±10.49mL/min,差异有统计学意义,t值为0.209,P值为0.015。t_(p)、t_(1/2)延长、C_(20)减低的患者比例在骨显像各组中差异均无统计学意义(P均>0.05)。结论^(99)Tc^(m)-DTPA肾动态显像可系统评价痛风患者肾小球滤过功能,能很好地反映痛风肾病肾功能受损程度,并显示痛风肾结晶结石、痛风性骨关节病变严重者肾脏受损更严重。联合肾动态显像和全身骨显像检查立体评价痛风病情是值得尝试应用的诊断Objective To analyze the characteristic of ^(99)Tc^(m)-DTPA renal dynamic imaging and ^(99)Tc^(m)-MDP bone scan in impaired kidney function of gouty patients,and to evaluate the clinical value of gout kidney damage.Methods We analyzed ^(99)Tc^(m)-DTPA renal dynamic imaging results of 128 patients,while 124 patients had the bone scan at the same time.We detected the glomerular filtration rate(GFR),the peak time(t_(p)),half emptying time(t_(1/2)),ratio of 20min and peak phase kidney radioactivity count(t 20/p)among patients.We then calculated C_(20).t and χ^(2) test were used for data analysis.Results(1)The total GFR and fractional GFR in patients who were older than 40 years old,having the disease course longer than 5 years and the level of serum creatinine more than normal were lower than the patients who were younger than 40 years old,having the diseases course shorter than 5 years and the normal level of serum creatinine(all P<0.05).The total GFR and fractional GFR had no significantly difference in gender,clinical stage,uric acid,microalbuminuria and alpha-1 globulins(all P>0.05).The percentage of C_(20)in the abnormal level of serum creatinine and microalbuminuria group were 47%and 46%,which were significantly higher than the normal level of serum creatinine and microalbuminuria group(17%and 19%),with χ^(2)=11.933,8.554,and P=0.001,0.003.t_(1/2)had no significant differences in every group(all P>0.05).(2)The fractional GFR in renal crystal or calculi group was 41.06±12.61mL/min,which was significantly lower than the group without crystal or calcuci,with t=-2.558,P=0.011.The total GFR,t_(p),t_(1/2)and C_(20)had no significant differences with or without renal crystal and calculi(all P>0.05).(3)The fractional GFR was 41.75±11.86mL/min in the group of more than three joints affected by gout,which was significantly lower than the group of less than three joints with 45.77±10.49mL/min.When the gout was affected the first metatarsophalangeal joints,the fractional GFR was 42.06±10.49mL/min,which was significan

关 键 词：肾动态显像 肾小球滤过率 骨显像 痛风 肾功能 DTPA 

分 类 号：R817.4[医药卫生—影像医学与核医学]