99Tcm-二乙三胺五乙酸肾动态显像在评价痛风患者肾功能中的应用

The value of 99Tcm-DTPA renal dynamic imaging for detecting renal function in patients with gouts

目的探讨99^Tcm-二乙三胺五乙酸（diethylenetriaminepentaaceticacid，DTPA）肾动态显像在评价痛风患者肾功能中的应用价值。方法：57例原发性痛风患者在我院行”Tcm-DTPA肾动态显像检查。按常规方法进行显像，获得肾血流灌注和肾动态系列图像，以Gates法测算肾小球滤过率（glomerularfiltrationrate，GFR），应用感兴趣区技术得到肾脏的时间一放射性曲线DTPA肾图并计算20rain清除率（clearancerateof20minutes，C20）等定量指标。将肾动态显像测得的GFR与同期血尿素氮（BUN）、血肌酐（SCr）、血尿酸（uricacid，UA）等血生化指标进行比较。结合肾动态显像图像及其他影像资料对分肾GFR和DTPA肾图进行分析，评估痛风患者的分肾功能和肾脏的排泄情况。结果痛风性肾损害在GFR轻度下降时BUN、SCr仍可保持正常水平。GFR低至60ml／min以下才有BUN、SCr明显升高。GFR变化早于BUN、SCr。在排除了尿路引流不畅等因素的影响之后，19．7％的患者表现为单肾GFR下降，22．3％GFR正常的肾脏出现了C20减低。UA水平则未随肾功能的恶化发生明显变化。结论肾动态显像测定的GFR等定量指标较血生化更为灵敏，并能评估分肾功能，是评价痛风患者肾功能的有效方法。

Objective To investigate the value of 99 ^Tcm-DTPA renal dynamic imaging in pa- tients with gouts. Methods A total of 157 gouts patients（ 153 male; age range 18~88 years） under- went conventional 99 ^Tcm-DTPA renal dynamic imaging from June 2011 to October 2014. After bolus injection of 111 ~ 185 MBq tracer, a series of images were obtained. DTPA renograms were genera- ted by the application of computer technology ROIs. GFR were calculated using Gates and C20 were gained also. The GFR detected by 99 Tcm-DTPA was compared with BUN, SCr and UA. Further- more, unilateral renal GFR and 02o was analysed. Results BUN and SCr still maintain a normal level when the GFR measurement by renal dynamic imaging decreased slightly. GFR was low as 60 ml/min or less, BUN and SCr increased significantly. The GFR changed earlier than BUN and SCr in gouts patients with renal damage. Excluding the impact of factors such as urinary tract obstruction, 19.7 of patients showed unilateral renal GFR decline. Reducing C20 was observed in 22.3 % kidneys with normal GFR. UA levels were not changed significantly with worsening renal function. Conclusions Radionuclide renal dynamic imaging is an effective method to assess the renal function in patients with gout.