^99Tc^m-二亚乙基三胺五乙酸肾动态显像对兔单侧急性上尿道梗阻的应用研究

The value of dynamic renal ^99Tc^m-diethylene triamine penta acetic acid imaging in rabbits with acute upper urinary tract obstruction

目的应用^99Tc^m-二亚乙基三胺五乙酸（^99Tc^m-DTPA）肾动态显像观察兔单侧急性上尿道梗阻不同时期肾功能的变化以及与梗阻解除后恢复状况的比较。方法健康家兔24只，手术制作左侧输尿管完全梗阻模型，术前及术后1周均行基础^99Tc^m-DTPA肾动态显像。选择梗阻后1周、3周、5～7周和8周以上不同时间点解除梗阻，并行^99Tc^m-DTPA利尿肾动态显像（利尿显像）。结果兔左侧输尿管形成梗阻后1周和3周，利尿显像可见左肾显影，但左肾肾小球滤过率（GFR）、摄取率降低，达峰时间延长，与术前比较有显著性差异（t=2．916，t=7．034，P〈0．01）。梗阻5～7周后，左侧肾脏仅见皮质显影，左肾GFR、摄取率明显降低，达峰时间明显延长，与术前比较有显著性差异（t=6．722，t=7．470，t=3．678，P〈0．01），梗阻后8周以上，未见明显肾皮质影像，无法进行图像分析。利尿显像示梗阻1-3周后解除梗阻4周观察到左肾GFR为31．23±14．4（t=2．627，P〈0．05），摄取率为4．09±2．10（t=2．795，P〈0．05），与解除梗阻前相比功能基本恢复；达峰时间与解除梗阻前无显著差异（t=1．435，P〉0．05）。梗阻5～7周后解除梗阻4周时左肾GFR、摄取率部分恢复，与解除梗阻前相比无显著差异。梗阻8周以上再解除梗阻，肾功能无法恢复。结论急性单侧上尿道完全梗阻后肾功能降低迅速，以早期最为显著，早期梗阻解除后肾功能恢复明显。晚期梗阻，即使解除梗阻肾功能也不易恢复。^99Tc^m-DTPA肾动态显像方法是评价肾功能恢复的有效手段。

Objective To research the degression of renal function of ^99Tc^m-diethylene triamine pentaaceticacid （^99Tc^m-DTPA） renal imaging in rabbits with acute upper urinary tract obstruction and its early recovery after relief. Methods Twenty-four health rabbit models with left acute upper urinary tract obstruction were buih up. ^99Tc^m-DTPA renal imaging was performed before making model and after obstruction 1, 3, 5-7 and more than 8 weeks respectively and 4 weeks after relief of obstruction. Results After obstnrction 1 and 3 weeks, ^99Tc^m-DTPA imaging showed development in left renal. Values of glomerular filtration rate （GFR） and uptake ratio decreased, while time to rcach the peak increased. These are obviusly different compared with those before obstruction （t=2.916, t=7.034, P〈0.01）. After obstruction 5-7 weeks, ^99Tc^m-DTPA imagingshowed cortex developert. Values of GFR and uptake ratio decreased obvious, while time to reach the peak increased obviously. These are obviously different cempaved with those before obstruction （t=6.722, t=7.470, t=3.678, P〈0.01）. After obstruction more than 8 weeks, ^99Tc^m-DTPA imaging showed no obvious development. In those rabbits with durations of 1-3 weeks obstructions, the renal function could almost recover within 4 weeks after relief of obstruction. GRF is 31.23±14.4 （t=2.627, P〈0.05） ,uptakc ratio is 4.09±2.10 （t=2.795, P〈0.05）. The time to reack the peak showed no obvious difference （t=1.435, P〉0.05）. With obstruction of 5-7 weeks, the GRF and uptake ratio, could recover partly to some extent. But with obstruction for more than 8 weeks, the renal function could not recover. Conclusions For the acute upper urinary tract obstruction, the renal function is most remarkable decreased in the early time, and can be restored after relief. For long time obstruction, even if relieved, the renal function is not easily to restore. The dynamic renal imaging can reflect the extent of the renal damage and its recovery, and could be used as a reliable indicator.