多指标联合评估肾积水患者肾脏功能  

An Evaluation of Renal Function in Patients with Hydronephrosisby Multi-index Combination

作　　者：杨艺伟 道日娜 康宇龙[3] 杨化龙 顾虹 YANG Yiwei;Daorina;KANG Yulong;YANG Hualong;GU Hong(Affiliated the Third Clinical College of Inner Mongolia Medical University,Baotou 014010,China;Department of Surgery,Xiwuzhumuqin Banner People’s Hospital,Xiwuzhumuqin Banner 026200,China;Department of Nuclear Medicine,Inner Mongolia Baotou Steel Hospital,Baotou 014010,China)

机构地区：[1]内蒙古医科大学第三临床医学院,内蒙古包头014010 [2]内蒙古西乌珠穆沁旗人民医院外科,内蒙古西乌珠穆沁旗026200 [3]内蒙古包钢医院核医学科,内蒙古包头014010

出　　处：《标记免疫分析与临床》2024年第11期1976-1982,共7页Labeled Immunoassays and Clinical Medicine

基　　金：中国金属学会冶金安全与健康分会健康卫生科研项目(编号:jkws202368);包头市卫生健康委科技计划项目(编号:wsjkwkj050)。

摘　　要：目的探究^(99)Tc^(m)-DTPA肾动态显像、CT平扫及血清klotho、β2-MG水平对肾积水患者肾脏功能的诊断价值。方法选取2023年1月至2024年1月于本院就诊的97例肾积水患者为肾积水组,根据影像学资料下肾积水程度分级分为轻度组(40例)、中度组(30例)和重度组(27例),同时纳入体检健康者50例为正常组。对所有受试者进行^(99)Tc^(m)-DTPA肾动态显像检查,计算GFR。腹部CT平扫分析肾实质厚度。采用全自动生化分析仪检测血清β_(2)-MG水平,酶联免疫吸附法检测血清Klotho水平。用Pearson法分析GFR与肾实质厚度、Klotho、β_(2)-MG间相关性;采用多因素Logistic回归分析影响肾积水患者肾功能的因素;采用ROC曲线评估^(99)Tc^(m)-DTPA肾动态显像、CT平扫、Klotho、β2-MG水平对肾积水患者肾功能的诊断价值。结果肾积水组GFR、肾实质厚度、Klotho水平低于正常组,β2-MG水平高于正常组(P<0.05)。轻度、中度、重度组GFR、肾实质厚度、Klotho水平依次降低,β2-MG水平依次升高(P<0.05)。GFR与肾实质厚度、Klotho水平呈正相关(r=0.436、0.502,P<0.05),与β2-MG水平呈负相关(r=-0.408,P<0.05);Klotho水平与肾实质厚度呈正相关(r=0.404,P<0.05),与β2-MG水平呈负相关(r=-0.413,P<0.05),β2-MG水平与肾实质厚度呈负相关(r=-0.471,P<0.05)。GFR、肾实质厚度、Klotho是影响肾积水患者肾功能的保护因素,β2-MG是危险因素(P<0.05)。GFR、肾实质厚度联合Klotho、β2-MG水平诊断肾积水患者肾功能的AUC为0.992,优于单一指标(Z GFR-联合=2.673,P=0.008;Z肾实质厚度-联合=4.807,P<0.05;Z Klotho-联合=3.511,P<0.001;Z_(β_(2)-MG-联合)=3.932,P<0.05),灵敏度和特异性分别为98.25%,97.50%。结论肾积水患者GFR、肾实质厚度及Klotho水平下调,β2-MG上调,^(99)Tc^(m)-DTPA肾动态显像联合CT平扫、Klotho、β2-MG对肾积水患者肾功能可能具有较好诊断价值。Objective To explore the diagnostic value of ^(99)Tc^(m)-DTPA renal dynamic imaging,non-contrast CT and the levels of serum klotho,β_(2)-microglobulin(β_(2)-MG)on renal function in patients with hydronephrosis.Methods We selected 97 patients with hydronephrosis who visited our hospital from January,2023 to January,2024 as the hydronephrosis group.According to the grade of hydronephrosis derived from imaging data,these patients were divided into the mild group(40 cases),moderate group(30 cases),and severe group(27 cases).In addition,50 healthy individuals who underwent physical examination were included as the normal group during the same period.^(99)Tc^(m)-DTPA renal dynamic imaging was performed on all subjects to calculate GFR.The thickness of renal parenchyma was analyzed by non-contrast CT.Fully automated biochemical analyzer was applied to detect serumβ2-MG level.Enzyme linked immunosorbent assay was performed to detect serum Klotho level.Pearson method was applied to analyze the correlation between GFR,renal parenchymal thickness and Klotho,β2-MG.Multivariate logistic regression was applied to identify potential impact factors affecting renal function in patients with hydronephrosis.ROC curve was drawn to evaluate the diagnostic value of nuclide renal dynamic imaging,non-contrast CT Klotho,andβ2-MG levels for renal function in patients with hydronephrosis.Results The GFR,renal parenchymal thickness and serum Klotho levels in the hydronephrosis group were significantly lower than those in the normal group,while theβ2-MG level was significantly higher than that in the normal group(P<0.05).The GFR,renal parenchymal thickness and serum Klotho levels decreased sequentially in the mild,moderate,and severe groups,while the level ofβ2-MG increased sequentially(P<0.05).GFR was positively correlated with renal parenchymal thickness and Klotho level(r=0.436,0.502,P<0.05),while negatively correlated withβ2-MG level(r=-0.394,P<0.05).Klotho level was positively correlated with renal parenchymal thickness(r=0.404,

关 键 词：^(99)Tc^(m)-DTPA肾动态显像 CT平扫 KLOTHO β_(2)-微球蛋白 肾积水 

分 类 号：R817.4[医药卫生—影像医学与核医学] R692[医药卫生—放射医学]