^99Tc^m-DTPA法肾小球滤过率在肾癌患者术前肾功能

The clinical significance of glomerular filtration rate measured by ^99Tc^m-diethylentriamine pentaacetic acid renal dynamic imaging in renal cell carcinoma patients before surgery

目的探讨^99Tc^m-DTPA法肾小球滤过率（GFR）在肾细胞癌（RCC）患者术前肾功能评价中的临床意义。方法99例RCC患者，其中行根治性肾切除术（RN）者89例，行保留肾手术（NSS）者10例。术前行^99Tc^m-亚乙基三胺五乙酸（^99Tc^m-DTPA）显像测定GFR。比较RCC患者和对照组（正常供肾者）的GFR差异以及RN组和NSS组患者的GFR差异，并比较GFR和血肌酐、尿素氮在评价RCC患者术前肾功能异常中的差异。统计学方法采用t检验和，检验。结果RCC患者双肾GFR[（76．4±20．4）ml／min]低于对照组[（80．6±17．4）ml／min]，但二者差异无统计学意义（t=0．650，P〉0．05）。19例（19．2％）RCC患者术前存在肾功能异常（双肾GFR〈60ml／min），而血肌酐异常（〉133μmol／L）者仅4例。RCC患者中，NSS组患侧肾脏GFR与RN组相比，差异无统计学意义[（34．1±11．7）ml／min vs．（37．9±11．9）ml/min，t=0．975，P〉0．05]，对侧肾脏GFR低于RN组[（32．7±10．3）ml／min眠（39．6±10．1）ml／min，t=0．044，P〈0．051，NSS组术前肾功能异常者比例明显高于RN组（50．0％vs.15．7％，r=6．808，P〈0．01）。结论^99Tc^m-DTPA法测定的GFR能获得RCC患者术前双肾和分肾功能的准确信息，对RCC患者的治疗决策有重要意义。

Objective To investigate the clinical significance of glomerular filtration rate （GFR） measured by ^99Tc^m-diethylenetriamine pentaacetic acid （^99Tc^m-DTPA） renal dynamic imaging in renal cell carcinoma （RCC）patients before surgery. Methods There were 99 cases of RCC patients, 89 patients undergoing radical nephrectomy （RN） and 10 patients undergoing nephron-sparing surgery （NSS）. ^99Tc^m-DTPA renal dynamic imaging was performed for determining GFR before surgery. Make a comparison of GFR between RCC group and control group （normal kidney donors）, RN group and NSS group. Make a comparison between GFR and serum creatinine in determining preoperative renal dysfunction of RCC patients. All of the data were analyzed by t-test and χ^2-text. Results Compared with contral group, total GFR of RCC patients was lower, but there was no significant difference[ （76.4± 20.4） ml/min vs. （80.6 ±17.4） ml/min, t=0.650, P 〉0.05）]. Nineteen cases （19.2%） of RCC patients had preoperative renal dysfunction （total GFR〈60 ml/min）, but only 4 cases performed abnormal serum creatinine （〉133 μ mol/L）. There was no significant difference in GFR of neoplastic kidneys between RN group and NSS group [（34.1 ±11.7） ml/min vs. （37.9 ±11.9） ml/min, t=0.975, P〉0.05]. GFR of contralateral kidneys was lower in NSS group than RN group [（32.7 ±10.3） ml/min vs. （39.6 ±10.1） ml/min, t=0.044, P〈0.05]. The percentage of preoperative renal dysfunction （total GFR〈60 ml/min） in NSS group was significantly higher than in RN group （50.0% vs. 15.7%,χ^2=6.808, P〈0.01）. Conclusion GFR can provide the accurate information of both kidneys and single kidney before surgery, and this result possessed an important significance in choice of treatments.