99Tcm-DTPA核素肾动态显像对糖尿病肾功能的评价

99Tcm-DTPA renal dynamic imaging in judgment of renal functions in patients with diabetes mellitus

目的探讨99Tcm-二亚乙基三胺五乙酸（99Tcm-DTPA）核素肾动态显像诊断糖尿病。肾病（DN）的价值。方法糖尿病（DM）患者90例，依据尿白蛋白排泄率（UAER）分为4组：①DM正常尿白蛋白（DM3）组；②DM微量尿白蛋白（DM2）组；③大量尿白蛋白（DM3）组；④肾功能不全（DM4）组；与正常对照（NC）组40例一起行放射性核素动态显像测定肾小球滤过率（GFR），同时测定尿素氮（BUN）、血清肌酐（SCr）、β2-微球蛋白（βrMG）。结果DM1组GFR明显高于NC组（t=12．5，P〈0．01），DM2组GFR与NC组相比无差异，但肾功能曲线半排时间（T1/2）延长，20min残流率（C20）增高。DM3、DM。组GFR明显低于对照组，T1/2更加延长，C20更高，随着DN的进展，UAER逐渐上升，GFR依次降低，二者呈显著负相关（r=-0．497，P〈0．05）。结论99Tcm-DTPA肾动态显像可早期诊断DN，并可了解肾功能受损程度，是反映DN损害的敏感指标。

Objective To evaluate 99Tcm-diethylenetriamine-pentaacetic acid （99Tcm-DTPA） renal dynamic imaging in judgment of the renal function inpatients with diabetes mellitus（DM） so as to provide reference for clinical treatment and prognosis predicting. Methods Ninety patients with DM were divided into four groups according to the values of urinary albumin excretion rate （UAER）. ①Group DM1： UAER 〈 20 μg ·min^-1, 25 cases. ②Gruop DM2： UAER 20-200 μg-min^-1, 24 cases. ③Group DM3： UAER 〉 200 μg. min^-1, 23 cases. ④a renal function failure group （DM4）, 18 cases. Fourty healthy people were chosen as normal control （NC） group. 99Tcm-DTPA radionuclide renal dynamic imaging of glcmerular filtration rate （GFR） was performed and the levels of serum creatinine （SCr）, blood urea nitrogen （BUN） and blood β2- micmglobulin （β2-MG） were measured in the five groups. Results GFR were significantly increased in group DMI than those in NC （t=12.5, P〈 0. 01）. In group DM2 GFR was not different from NC. The half activity time （T1/2） of the renogram was significantly prolonged. The 20 min retention rate （C20） of the renogram increased compared with NC. In group DM3 and DM4, GFR was remarkably decreased. The peak time （TP） of the renogram delayed. T1/2 distinctly prolonged and C20 increased, comparing with NC （r=0.497, P〈0.05）. Conclusion Radionuclide renal dynamic imaging is helpful for the evaluation of renal damage in early stage of diabetic nephropatby （DN）, judge the injury of the renal function and provide reference for clinical t treatment and follow-up.