^(99m)Tc-DTPA肾动态显像与CysC在早期糖尿病肾病的诊断价值

^(99m)TC-DTPA renal dynamic imaging and CysC in the diagnosis of early diabetic nephropathy

目的探讨99m锝-二乙基三胺五乙酸(99mTc-DTPA)肾动态显像与胱抑素C(CysC)在早期糖尿病肾病的诊断价值。方法选择2型糖尿病患者共125例,分为正常蛋白尿组(75例)、微量蛋白尿组(37例)和大量蛋白尿组(13例)。进行99mTc-DTPA肾动态显像,测定血清CysC、血肌酐(Scr)等,对根据CysC计算的肾小球滤过率(CysCGFR)与根据Cockcrofi-Ganct公式计算的肾小球滤过率(CG-GFR)进行对比分析。结果微量蛋白尿组中99mTc-DTPA-GFR显著低于正常蛋白尿组,血清CysC水平显著高于正常蛋白尿组,但Scr水平在微量蛋白尿组中与正常蛋白尿组无统计学差异。以99mTc-DTPA-GFR为判断标准,分别以90 ml/(min·1.73 m2)和75 ml/(min·1.73 m2)为分割点,结果 CysC-GFR的诊断符合率分别为87.5%和89.3%,均高于CG-GFR。结论 CysC-GFR可以敏感、准确地反映2型糖尿病早期肾损害的GFR功能,比99mTc-DTPA-GFR测定更为简便,较CG-GFR更为准确,值得临床推广。

Objective To investigate the diagnostic value of 99m Tc - DTPA renal dynamic imaging and CysC in the diagnosis of early di-abetic nephropathy. Methods A total of 125 patients with type 2 diabetes was collected and divided into normal albuminuria group（75 cases）, trace albuminuria group（37 cases）and heave albuminuria group（13 cases）. 99m Tc - DTPA renal dynamic imaging and the detection of serum CysC,Scr,etc. were undertaken. CysC - GFR and Cockcrofi - Ganct（ CG）- GFR were used to calculate and analyze. Results 99m Tc -DTPA - GFR in trace albuminuria group was significantly lower than that of normal albuminuria group. The serum CysC level was significantly higher than normal albuminuria group,but the level of Scr in the trace albuminuria group and normal albuminuria group did not show statistical difference. With99mTc - DTPA - GFRasthegoldstandardand90ml/（min·1.73m2）or75ml/（min·1.73m2）ascutoffpoints,coinci-dence rate of CysC - GFR diagnosis was 87. 5% and 89. 3%,respectively,which were higher than CG - GFR. Conclusion CysC - GFR can sensitively,accurately reflect the early renal damage in type 2 diabetes,more simple than 99m Tc - DTPA - GFR,more accurate than the CG- GFR,which was worthy of clinical promotion.