肾移植急性肾小管坏死的单光子发射计算机断层评价研究

SPECT evaluation of ATN in kidney transplant recipients

肾移植术后急性肾小管坏死（ＡＴＮ）发生率高，鉴别诊断困难。本研究对６８例肾移植病人作了８３次单光子发射计算机断层（ＳＰＥＣＴ）检测，发现ＡＴＮ和急性排斥反应均表现摄取慢而少伴皮质滞留，但后者同时有明显肾肿大及灌注异常；超排和急性加速性排斥肾不显影、显影不清或为“负影”，严重ＡＴＮ时也可显影不清，但血流灌注尚可；灌注期及摄取早期肾实质内放射性稀疏区是上尿路梗阻的典型特征；ＣｓＡ肾中毒则以摄取障碍为主，伴有一定排泄障碍。

Eighty-three tests of SPECT have beengiven in 68 cases of renal graft recipients.Lowand slow uptake coupled with cortical reten-tion was seen in ATN, and also in acute rejec-tion but simultaneously with poor perfusionand obvious graft enlargement.Severely pooror non visualization is the main feature of su-peracute rejection and accelerated acute rejec-tion. Though severe ATN was also poorly vi-sualized in image,it had relatively normal per-fusion. The obstruction of upper urinary tractwas specifically characterized by activity at-tenuation area in renal parenchyma during theperfusion and early uptake period.Low uptakeand a little decreased excretory function wereseen in uncomplicated CsA nephrotoxicity.