^(99)Tc^(m)-DTPA肾动态显像探索甲状腺功能减退症对肾功能的影响及机制  

Impact of hypothyroidism on renal function and its mechanism revealed by ^(99)Tc^(m)-DTPA renal dynamic imaging

作　　者：杨佳欢 钟鹏 柴红 陈泽泉 陈立波 Yang Jiahuan;Zhong Peng;Chai Hong;Chen Zequan;Chen Libo(Department of Nuclear Medicine,Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China)

机构地区：[1]上海交通大学医学院附属第六人民医院核医学科,上海200233

出　　处：《中华核医学与分子影像杂志》2025年第1期19-23,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探索^(99)Tc^(m)-二乙撑三胺五乙酸(DTPA)肾动态显像定量评价甲状腺功能减退症对肾功能的影响并探讨其机制。方法前瞻性纳入2022年10月至2023年10月就诊于上海交通大学医学院附属第六人民医院拟行术后^(131)I残余甲状腺组织消融的分化型甲状腺癌患者35例,其中男12例、女23例,年龄(44.8±10.7)岁。分别测定左甲状腺素钠片(L-T_(4))撤除前和撤除后4周血清甲状腺相关指标和肾功能参数。采用^(99)Tc^(m)-DTPA肾动态显像测定肾小球滤过率(GFR)、高峰时间和半排时间。采用配对t检验、Wilcoxon符号秩检验、Wilcoxon秩和检验分析数据。结果与L-T_(4)撤除前相比,35例患者L-T_(4)撤除4周后,GFR[(95.80±18.09)与(89.86±15.58)ml/min;t=4.83,P<0.001]、估计的GFR(eGFR)[(108.27±18.39)与(87.97±16.24)ml·min^(-1)·1.73 m^(-2);t=9.37,P<0.001]、胱抑素C水平[(0.72±0.12)与(0.64±0.15)mg/L;t=3.73,P=0.001]明显下降,且男性GFR下降幅度明显高于女性[6.16(3.62,14.89)与3.83(0.57,8.25)ml/min;Z=-1.98,P=0.048]。此外,^(99)Tc^(m)-DTPA肾动态显像发现左、右肾高峰时间较停药前明显延长[3.03(2.53,3.78)与3.04(2.53,4.13)min;Z=-3.85,P<0.001;3.14(2.46,4.20)与3.50(2.74,4.50)min;Z=-3.44,P=0.001],但左、右肾半排时间均无明显变化(Z值:-0.88、-0.48,P值:0.381、0.634)。结论^(99)Tc^(m)-DTPA肾动态显像证实甲状腺功能减退症可引起肾功能减退;肾血流灌注量降低是其可能的参与机制。Objective To quantitatively evaluate the impact of hypothyroidism on renal function and address its underlying mechanisms using ^(99)Tc^(m)-diethylene triamine pentaacetic acid(DTPA)renal dynamic imaging.MethodsA total of 35 patients with differentiated thyroid cancer(12 males,23 females,age(44.8±10.7)years),who were referred for radioiodine remnant ablation,were consecutively enrolled prospectively from October 2022 to October 2023 in Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine.Serum examinations of thyroid-and renal function-relevant parameters and ^(99)Tc^(m)-DTPA renal dynamic imaging were performed before and 4 weeks after stopping taking levothyroxine(L-T_(4)).Paired t test,Wilcoxon signed rank test and Wilcoxon rank sum test were used to analyze data.ResultsAfter L-T_(4) withdrawal,glomerular filtration rate(GFR)derived from renal dynamic imaging,estimated GFR(eGFR),and cystatin C level significantly decreased((95.80±18.09)vs(89.86±15.58)ml/min;t=4.83,P<0.001;(108.27±18.39)vs(87.97±16.24)ml·min^(-1)·1.73 m^(-2);t=9.37,P<0.001;(0.72±0.12)vs(0.64±0.15)mg/L;t=3.73,P=0.001).GFR decreased more robustly in male patients than in females(6.16(3.62,14.89)vs 3.83(0.57,8.25)ml/min;Z=-1.98,P=0.048).Additionally,^(99)Tc^(m)-DTPA renal dynamic imaging revealed that the peak times of both left and right kidneys were significantly prolonged(3.03(2.53,3.78)vs 3.04(2.53,4.13)min;Z=-3.85,P<0.001;3.14(2.46,4.20)vs 3.50(2.74,4.50)min;Z=-3.44,P=0.001),but the left and right renal half-excretion times remained stable(Z values:-0.88,-0.48,P values:0.381,0.634).ConclusionBased on the ^(99)Tc^(m)-DTPA renal dynamic imaging results,it can be demonstrated that hypothyroidism can lead to a significant decrease in renal function,and the possible reason might be the reduction in the blood perfusion of kidneys.

关 键 词：甲状腺功能减退症 肾小球滤过率 放射性核素显像 99M锝五乙酸盐 

分 类 号：R581.2[医药卫生—内分泌] R817.4[医药卫生—内科学]