静脉肾盂造影示无功能肾患者的肾功能状态评估

Dynamic renal scintigraphy versus dual-plasma sample clearance for determining glomerular filtration rates in patients with nonfunctioning kidneys shown by intravenous pyelography

目的应用99Tcm-DTPA SPECT肾动态显像技术评估静脉肾盂造影（IVP）示无功能肾患者的实际肾功能状态。方法回顾性分析2012年1月~2014年6月在我院进行IVP检查提示无肾功能,并同时进行了99Tcm-DTPA SPECT肾动态显像的107例泌尿外科肾疾病患者,研究患侧肾双血浆法GFR测定值（GFR_（双血浆））及Gates＇法GFR测定值（GFRGates＇）,结合功能动态影像,将测量结果按GFR_（双血浆）值分成4组：（1）轻度受损组：GFR_（双血浆）≥30 m L/min;（2）中度受损组：GFR_（双血浆）介于20~30 m L/min;（3）重度受损组：GFR_（双血浆）介于10~20 m L/min;（4）无功能组：GFR_（双血浆）≤10 m L/min,计算各构成比并比较各组GFR_（双血浆）及GFRGates＇。结果 107例IVP无功能肾患者中,GFR_（双血浆）提示肾功能轻度受损、中度受损、重度受损、无功能分别为12例（11.2%）、33例（30.8%）、41例（38.3%）、21例（19.6%）,GFR_（双血浆）和GFRGates＇在肾功能轻、中度受损组中差异无统计学意义,肾功能重度受损组GFR_（双血浆）值为13.9±6.2 m L/min,低于GFRGates＇的18.8±4.2 m L/min,t=-2.73,P=0.03,差异有统计学意义;无肾功能组GFR_（双血浆）值为4.5±2.1 m L/min,低于GFRGates＇的7.2±3.2 m L/min,t=-3.81,P=0.005,差异有统计学意义。结论 IVP检查提示无功能的肾疾病患者只有58%的患者肾功能受损在重度及以下,术前需要进一步行SPECT肾动态显像检查来评估患肾的真实肾功能状态。

Objective To study the actual glomerular filtration rates（GFR） in patients with nonfunctioning kidneys as shown by intravenous pyelography（IVP） using single photon emission computed tomography（SPECT） dynamic renal scintigraphy and dual-plasma sample clearance method.Methods We retrospectively analyzed 107 patients with nonfunctioning kidneys shown by IVP who underwent renal dynamic99Tcm-DTPA SPECT imaging.GFR was measured by Gates＇ methods（GFRGates＇）and dual-plasma sample clearance method（GFRdual-plasma）.Based on the dynamic functional images and GFRdual-plasma measurements,the patients were categorized into mild renal impairment（GFR_（dual-plasma）≥30 m L/min）,moderate renal impairment group（GFRdual-plasmaof 20-30 m L/min）,severe renal impairment group（GFRdual-plasmaof 10 to 20 m L/min）,and nonfunctioning kidney group（GFRdual-plasma≤10 m L/min）,and GFRGates＇ were compared among the groups.Results According to GFRdual-plasma,the numbers of patients having mild,moderate,and severe renal impairment and nonfunctioning kidneys were 12（11.2%）,33（30.8%）,41（38.3%）,and 21（19.6%）,respectively.GFRdual-plasmaand GFRGates＇ were not significantly different in mild and moderate renal impairment groups,but in patients with severe renal impairment,GFR_（dual-plasma）was significantly lower than GFRGates＇（13.9±6.2 vs 18.8±4.2 m L/min; t=-2.73,P=0.03）,which was also the case with patients with nonfunctinging kidneys（4.5±2.1 vs 7.2±3.2ml/min; t=-3.81,P=0.005）.Conclusion Of the patients with nonfunctinging kidneys shown by IVP,only 58% of them actually have severe renal impairment or worse,and further SPECT dynamic renal scintigraphy is necessary to assess the actual risk of renal function impairment before operation.