Gates法测定肾小球滤过率的精确性及与病理对照分析

The precision of glomerular filtration rate determined by Gates method and compared with the results from renal pathological changes

目的 探讨Gates法测定GFR的精确性,及其与肾病理改变之间的相互关系,获得Gates法测定GFR的适用范围.方法 选取99Tcm-DTPA肾功能曲线中双肾均无明显b段（即无超滤液形成段,A组）及双肾均有明显b段（B组）肾病患者各27例,比较Gates法测定GFR与CockcroftGault（C-G）公式、肾病膳食改良试验（MDRD）方程评估GFR及SCr之间的相关性,2组间病理结果（肾小球硬化分数和肾小管间质病变分数）差异行t检验比较.结果 线性相关分析证实：A组中,Gates法测定的GFR与C-G公式、1/SCr之间无明显相关性（r=0.357,0.376,P均＞0.05）与MDRD方程估算的GFR有明显相关性（r=0.440,P＜0.05）;B组中,Gates法测定的GFR与C-G公式、MDRD方程估算的GFR及1/SCr之间有正相关性（r=0.471,0.527,0.452,P均＜0.05）.A组肾小球硬化分数与B组差异无统计学意义,分别为0.26±0.24,0.27±0.21（t=-0.146,P＞0.05）,A组肾小管间质病变分数与B组差异有统计学意义,且较B组严重,分别为7.15±2.32,3.70±3.06（t=4.663,P＜0.001）.结论 99Tcm-DTPA肾功能曲线中双肾均无明显b段时,Gates法测定GFR的精确度明显低于双肾有明显b段者;99Tcm-DTPA肾功能曲线中双肾无明显b段与肾小管间质严重病变相关.

Objective To evaluate the precision of GFR using Gates method and compared with the results from renal pathological changes. Methods Twenty-seven patients whose 99Tcm-DTPA renograms had no obvious uptake phase were enrolled in Group A, and 27 patients whose 99Tcm-DTPA renograms had obvious uptake phase were enrolled in Group B. The measurement of GFR by Gates method was compared to the creatinine clearance measured and predicted by Cockroft-Gault （C-G）, modification of diet in renal disease （MDRD） and SCr level. Renal pathological changes in two groups were compared using Pearson correlation and t test analysis. Results In Group A, GFR determined by Gates method did not show correlation with that estimated by C-G or 1/SCr （r = 0. 357,0. 376, both P 〉0.05）, but was significantly correlated with GFR estimated by MDRD（r = 0. 440, P 〈 0.05）. In Group B, GFR determined by Gates method showed significantly correlation among GFR estimated by MDRD, C-G, and 1/SCr （r =0. 471, 0. 527,0. 452, all P 〈 0.05）. Renal tubulointerstitial damage score in Group A was higher than that in Group B （7.15±2.32, 3.70±3.06, t=4.66, P 〈0.001）. Conclusions GFR determined by Gates method is less precise when 99Tcm-DTPA renogram has no obvious uptake phase than that when 99Tcm-DTPA renogram has obvious uptake phase. Renal tubulointerstitial damage is a strong indicator of no obvious uptake phase in 99Tcm-DTPA renogram.