南方医科大学学报

南方医科大学学报 ›› 2016, Vol. 36 ›› Issue (07): 1021-.

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静脉肾盂造影示无功能肾患者的肾功能状态评估

胡志辉，孙涛涛，王淑侠，朱林波   

  • 出版日期:2016-07-20 发布日期:2016-07-20

Dynamic renal scintigraphy versus dual-plasma sample clearance for determining glomerular filtration rates in patients with nonfunctioning kidneys shown by intravenous pyelography

  • Online:2016-07-20 Published:2016-07-20

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摘要： 目的应用99Tcm-DTPA SPECT肾动态显像技术评估静脉肾盂造影（IVP）示无功能肾患者的实际肾功能状态。方法回顾 性分析2012年1月~2014年6月在我院进行IVP检查提示无肾功能，并同时进行了99Tcm-DTPA SPECT肾动态显像的107例泌尿 外科肾疾病患者，研究患侧肾双血浆法GFR测定值（GFR双血浆）及Gates’法GFR测定值（GFRGates’），结合功能动态影像，将测量结 果按GFR双血浆值分成4组：（1）轻度受损组：GFR双血浆≥30 mL/min；（2）中度受损组：GFR双血浆介于20~30 mL/min；（3）重度受损组： GFR双血浆介于10~20 mL/min；（4）无功能组：GFR双血浆≤10 mL/min，计算各构成比并比较各组GFR双血浆及GFRGates’。结果107 例 IVP 无功能肾患者中，GFR双血浆提示肾功能轻度受损、中度受损、重度受损、无功能分别为12 例（11.2%）、33 例（30.8%）、41 例（38.3%）、21 例（19.6%），GFR双血浆和GFRGates’在肾功能轻、中度受损组中差异无统计学意义，肾功能重度受损组GFR双血浆 值为13.9±6.2 mL/min，低于GFRGates’的18.8±4.2 mL/min，t=-2.73，P=0.03，差异有统计学意义；无肾功能组GFR双血浆值为4.5± 2.1 mL/min，低于GFRGates’的7.2±3.2 mL/min，t=-3.81，P=0.005，差异有统计学意义。结论IVP检查提示无功能的肾疾病患者只 有58%的患者肾功能受损在重度及以下，术前需要进一步行SPECT肾动态显像检查来评估患肾的真实肾功能状态。

Abstract: Objective To study the actual glomerular filtration rates (GFR) in patients with nonfunctioning kidneys as shown by intravenous pyelography (IVP) using single photon emission computed tomography (SPECT) dynamic renal scintigraphy and dual-plasma sample clearance method. Methods We retrospectively analyzed 107 patients with nonfunctioning kidneys shown by IVP who underwent renal dynamic 99Tcm-DTPA SPECT imaging. GFR was measured by Gates’ methods (GFRGates’) and dual-plasma sample clearance method (GFRdual-plasma). Based on the dynamic functional images and GFRdual-plasma measurements, the patients were categorized into mild renal impairment (GFRdual-plasma≥30 mL/min), moderate renal impairment group (GFRdual-plasma of 20-30 mL/min), severe renal impairment group (GFRdual-plasma of 10 to 20 mL/min), and nonfunctioning kidney group (GFRdual-plasma≤10 mL/min), and GFRGates’ were compared among the groups. Results According to GFRdual-plasma, the numbers of patients having mild, moderate, and severe renal impairment and nonfunctioning kidneys were 12(11.2%), 33 (30.8%), 41(38.3%), and 21(19.6%), respectively. GFRdual-plasma and GFRGates’ were not significantly different in mild and moderate renal impairment groups, but in patients with severe renal impairment, GFRdual-plasma was significantly lower than GFRGates’ (13.9± 6.2 vs 18.8±4.2 mL/min; t=-2.73, P=0.03), which was also the case with patients with nonfunctinging kidneys (4.5±2.1 vs 7.2±3.2 ml/min; t=-3.81, P=0.005). Conclusion Of the patients with nonfunctinging kidneys shown by IVP, only 58% of them actually have severe renal impairment or worse, and further SPECT dynamic renal scintigraphy is necessary to assess the actual risk of renal function impairment before operation.