摘要目的 探讨99Tcm-二亚乙基三胺五乙酸(99Tcm-DTPA)肾动态显像Gate's法及血肌酐估测法在多囊肾各时期肾小球滤过率(GFR)检测中的应用价值.方法 选择2006年1月至2018年9月未行透析治疗的多囊肾患者59例.参考美国慢性肾脏病及透析的临床实践指南,依据慢性肾病(CKD)分期(1～5期),以双血浆法测定GFR为参考标准,将多囊肾患者分为3组.A组:GFR ≥60 mL/ (min· 1.73m2),CKD分期为1～2期,共19例;B组:60 mL/(min· 1.73 m2)＞GFR≥30 mL/ (min· 1.73 m2),CKD分期为3期,共23例;C组:GFR＜30 mL/(min· 1.73 m2),CKD分期为4～5期,共17例.将Gate's法、血肌酐估测法测定的GFR分别与双血浆法测定的结果进行配对t检验和Pearson相关分析.结果 (1)血肌酐估测法测得的A、B、C3组的GFR分别为(85.43±19.77)、(46.56±15.48)、(20.96±11.3) mL/ (min· 1.73 m2),双血浆法测得的GFR分别为(80.58±16.2)、(42.66±7.63)、(18.61 ±7.21) mL/(min· 1.73 m2),两者间的差异均无统计学意义(t=-1.462、-1.592、-1.791,均P＞0.05),且均有很好的相关性(r=0.69、0.68、0.92,均P＜0.05).(2)Gate's法测得的A、B、C3组的GFR分别为(75.39±20.75)、(42.86± 18.95)、(25.85±14.91) mL/(min· 1.73 m2),与双血浆法测定的GFR比较,两者在A、B组中的差异均无统计学意义(t=1.255、-0.061,均P＞0.05),且均有很好的相关性(r=0.55、0.62,均P＜0.05);但是,两者在C组中的差异有统计学意义(t=-2.132,P＜0.05),且无明显相关性(r=0.36,P＞0.05).结论 Gate's法可很好地评估多囊肾CKD分期为1～3期的患者的肾功能GFR,但对CKD分期为4～5期的患者不适合.血肌酐估测法可有效评价多囊肾CKD各时期的肾功能GFR.

abstractsObjectives To investigate the application value of 99Tcm-diethylene-triaminepentaacetic acid(99Tcm-DTPA) renal dynamic imaging (method A) and blood creatinine estimation method(method B) in glomerular filtration rate (GFR) detection in different stages of polycystic kidney diseases.Methods A total of 59 polycystic kidney patients without dialysis were divided into the following groups by the gold standard method of double plasma (method C):Group A,GFR≥60 mL/(min· 1.73 m2) (including chronic kidney disease(CKD)l-2,19 cases);Group B,60 mL/(min· 1.73 m2) ＞ GFR ≥ 30 mL/(min· 1.73 m2) (including CKD 3,23 cases);Group C,GFR ＜ 30 mL/(min· 1.73 m2) (including CKD 4-5,17 cases).The method A GFR and method B GFR were respectively matched with the method C GFR for t-test and Pearson correlation analysis.Results (1) The method B GFR in Group A,B and C were (85.43±19.77),(46.56±15.48),(20.96±11.3) mL/(min· 1.73 m2).The method C GFR were (80.58±16.2),(42.66±7.63),(18.61±7.21) mL/(min · 1.73 m2) respectively.There was no significant difference between method B and method C in Groups A,B and C(t=-1.462,-1.592,-1.791,all P＞0.05).In each group,the method B had a good correlation with method C (r=-0.69,0.68,0.92,all P＜0.05);(2) The method A GFR in Group A,B and C were (75.39±20.75),(42.86±18.95),(25.85±14.91) mL/(min· 1.73 m2).There was no significant difference between method A and method C in Groups A and B(t =1.255,-0.061,both P＞0.05);A significant correlation between method A and method C in both groups was observed (r=0.55,0.62,both P＜0.05);In Group C,no significant difference (t=-2.132,P＜0.05) and correlation (r=0.36,P＞0.05) between method A and method C.Conclusions Gate's method can evaluate renal function in the early stage of polycystic renal disease(CKD 1-3),but the late stage(CKD 4-5) is unsuitable.The blood creatinine estimation method (using the Cockcroft-Gault equation) can evaluate all stages of the renal function of the polycystic kidney disease.