核素肾动态显像联合双血浆法在单侧肾积水患者介入治疗前后分肾GFR评估中的应用  

Application of radionuclide renal dynamic imaging combined with double plasma method in evaluation of split renal glomerular filtration rates pre-and post-interventional treatment in patients with unilateral hydronephrosis

作　　者：吴宇平 陆克义[1] 张潇宇 李聪革[1] 胡光[1] Wu Yuping;Lu Keyi;Zhang Xiaoyu;Li Congge;Hu Guang(Department of Nuclear Medicine,First Hospital of Shanxi Medical University,Collaborative Innovation Center for Molecular Imaging of Precision Medicine,Taiyuan 030001,China)

机构地区：[1]山西医科大学第一医院核医学科、分子影像精准诊疗省部共建协同创新中心,太原030001

出　　处：《中华核医学与分子影像杂志》2022年第8期473-477,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨99Tcm-二乙撑三胺五乙酸(DTPA)核素肾动态显像联合双血浆法肾小球滤过率(GFR)测定在成人单侧肾积水手术治疗前后分肾功能评估中的价值。方法回顾性分析2015年1月至2019年12月间山西医科大学第一医院成人单侧肾积水患者79例[男39例、女40例,年龄(41.4±16.3)岁],均行介入手术解除梗阻。手术前后均行99Tcm-DTPA肾动态显像,获得双肾肾图及Gates法测定GFR(记为gGFR),同时行校正的双血浆法测定双肾GFR(记为dGFR总)。根据肾图的分肾比值及dGFR总,得到患肾双血浆法GFR(记为dGFR)。依据术前患肾dGFR,将患者分为轻中度(dGFR≥20且<40 ml·min^(-1)·1.73 m^(-2))、重度(dGFR≥10且<20 ml·min^(-1)·1.73 m^(-2))与极重度组(dGFR<10 ml·min^(-1)·1.73 m^(-2))。术后复查肾动态显像和dGFR,分析术后患肾GFR恢复值(ΔgGFR、ΔdGFR)。采用χ2检验、配对t检验、单因素方差分析、Pearson相关分析和Bland-Altman一致性检验分析数据。结果79例单侧肾积水患者中轻中度组34例,重度组24例,极重度组21例。轻中度组、极重度组患肾术后gGFR、dGFR与术前比较,差异均有统计学意义(t值:2.42~3.34,均P<0.05),重度组术前、术后差异无统计学意义(t值:1.24、1.27,均P>0.05)。3组间ΔgGFR、ΔdGFR比较,差异均无统计学意义(F值:0.45、0.34,均P>0.05)。组内2种方法测得的患肾GFR相关性较好(术前r值:0.68~0.82;术后r值:0.80~0.91,均P<0.001)。轻中度与重度组2种方法测得的GFR一致性欠佳,手术前后均有>5%的值超出95%的一致性界限范围[轻中度组,5.88%(2/34);重度组,8.33%(2/24)];而极重度组2种方法一致性较好,手术前后超出95%的一致性界限范围的值均<5%[4.76%(1/21)]。结论单侧肾积水患者术前分肾GFR不能预测介入术后肾功能恢复情况。对于单侧上尿路梗阻性肾积水患肾GFR的评价,校正的双血浆法测定GFR结合肾图的分肾比值较为合适,而Gates法有一定局限性,但可推荐用于Objective To explore the value of 99Tcm-diethylene triamine pentaacetic acid(DTPA)renal dynamic imaging combined with double plasma glomerular filtration rate(GFR)in the evaluation of split renal function in adult patients undergoing interventional therapy for unilateral hydronephrosis.Methods Retrospective analysis of 79 patients(39 males,40 females,age(41.4±16.3)years)with unilateral hydronephrosis in First Hospital of Shanxi Medical University from January 2015 to December 2019 were performed.All patients underwent surgery to relive obstruction.99Tcm-DTPA renal dynamic imaging was performed before and after surgery to obtain bilateral renogram and GFR was measured by Gates method(marked as gGFR).Meanwhile,the corrected double plasma method was used to measure the GFR of both kidneys(marked as dGFRall).Double plasma GFR of the affected kidney(marked as dGFR)was obtained according to the ratio of renogram and dGFRall.Patients were divided into mild to moderate group(dGFR≥20 and<40 ml·min^(-1)·1.73 m^(-2)),severe group(dGFR≥10 and<20 ml·min^(-1)·1.73 m^(-2))and extremely severe group(dGFR<10 ml·min^(-1)·1.73 m^(-2))according to dGFR before surgery.Postoperative renal dynamic imaging and dGFR were reexamined to analyze the GFR recovery values(ΔgGFR,ΔdGFR).Data were analyzed byχ2 test,paired t test,one-way analysis of variance,Pearson correlation analysis and Bland-Altman consistency test.Results There were 34 patients in mild to moderate group,24 patients in severe group,21 patients in extremely severe group.Significant differences were found in both gGFR and dGFR before and after surgery in mild to moderate group,as well as those in the extremely severe group(t values:2.42-3.34,all P<0.05),but there was no significant difference in severe group(t values:1.24,1.27,both P>0.05).TheΔgGFR andΔdGFR were not significantly different among three groups(F values:0.45,0.34,both P>0.05).GFR mesured by the 2 methods(gGFR,dGFR)before and after operation correlated well in each group(before surgery,r values:0.6

关 键 词：肾盂积水 肾小球滤过率 放射性核素显像 体层摄影术 X线计算机 99M锝五乙酸盐 

分 类 号：R692.7[医药卫生—泌尿科学]