单光子发射断层成像99mTc-DTPA肾动态显像在移植肾监测中的应用

Application of SPECT 99mTc-DTPA renal dynamic imaging in monitoring of the transplanted kidney

目的探讨单光子发射断层成像(SPECT)99mTc-DTPA肾动态显像在监测异体移植肾排异反应的应用价值。方法对该院收治的对60例异体肾移植患者为观察对象,术后随访半年,随访间隔2个月。根据随访结果分为四组:功能稳定组,33例肾功能稳定;慢性排异组,5例发生慢性排斥反应;急性排异组,19例发生急性排斥反应;急性肾小管坏死(ATN)组,3例发生急性肾小管坏死。四组均接受99mTc-DTPA肾动态示踪剂SPECT检查,分析四组患者检查指标差异。结果稳定组显像清晰,而其他3组均早期肾影欠清晰。稳定组的肾小球滤过率(GFR)及K/A(移植肾最大放射性计数/主动脉最大放射性计数)均最高(P<0.05),且B/K(25min膀胱放射性计数/移植肾最大放射性计数)均大于1。随访第1个月慢性排异组的GFR及K/A值高于急性排异组及ATN组(P<0.05),而急性排异组及ATN组差异无统计学意义(P>0.05);随访第2个月起慢性排异组与急性排异组的GFR及K/A值均差异无统计学意义(P>0.05),而ATN组GFR及K/A值显著较高(P<0.05)。3组的B/K值均小于1。结论SPECT 99mTc-DTPA肾动态显像能早期评估异体移植肾排斥反应发生情况,并对发生急性肾小管坏死具有鉴别价值。

[Objective]To analyze the clinical value of single photon emission computed tomography（SPECT）99mTc-DTPA renal dynamic imaging in the allotransplant kidney rejections. [Methods]A total of 60 patients admitted to our hospital for kidney allotransplantation were selected as the observation subjects. After post-operation,all patients were received a half-year follow-up and the interval was two months. All patients were divided into four groups according to the results of the follow-up, which were stable function group（33 cases, the renal function was stable）, chronic rejection group（5 cases, the renal chronic rejection happened）, acute rejection group（19 cases, the renal acute rejection happened） and acute renal tubular necrosis（ATN） group（3 cases, the ATN happened）. All patients were received the SPECT 99mTc-DTPA renal dynamic imaging. The indexes of the examination were compared among four groups.[Results]The stable function group showed clear imaging, while the other groups showed poor renal imaging. The indexes of glomerular filtration rate（GFR） and K/A in the stable function group was highest（P〉0.05） and the index of B/K was more 1. At the first month follow-up, the indexes of GFR and K/A in the chronic rejection group were higher than in the acute rejection group and ATN group（P〉0.05）, but the indexes of GFR and K/A were no different between acute rejection group and ATN group（P〉0.05）. From the second month followup, the indexes of GFR and K/A were no different between chronic rejection group and acute rejection group（P〉0.05）, but the indexes of GFR and K/A in the ATN group were higher than the two other groups（P〈0.05）. The index of B/K in the three groups was less 1.[Conclusion]The SPECT 99mTc-DTPA renal dynamic imaging has reference value for the diagnosis of rejections and identification of acute tubular necrosis.