99mTc-DTPA核素肾动态显像评价主动脉夹层患者术后肾功能受损研究

The evaluation of impairment of renal function on postoperative aortic dissection patients by 99mTc-DTPA renal dynamic imaging

目的:应用99mTc-DTPA肾动脉显像评价Stanford不同分型主动脉夹层患者术后左、右侧肾功能及总体肾功能受损程度,帮助临床制定进一步的治疗方案,改善患者预后。方法:回顾性分析2018年3月8日至2019年7月19日,在本院核医学科行99mTc-DTPA肾动态显像的主动脉夹层术后患者48例,评价患者双肾血流灌注、总肾小球滤过率(GFR)和分肾的GFR,比较Stanford主动脉夹层A型(简称A型)患者和主动脉夹层B型(简称B型)患者之间总肾功能及分肾功能,血肌酐、血尿素氮及血尿酸水平的差异。结果:B型患者术后总GFR低于A型患者(67.5 vs.80.6 m L/min,P<0.05),其中以左肾功能受损为著(30.9 vs.40.3 m L/min,P<0.05),差异有统计学意义。结论:肾动态显像对主动脉夹层术后患者早期评价肾功能有重要价值。主动脉夹层B型患者GFR较A型减低,且左侧肾GFR减低更明显,临床可以早期采取干预措施,改善主动脉夹层患者预后。

Objective:To evaluate the left and right renal function and overall renal impairment in postoperative patients with different Stanford dissection by 99mTc-DTPA renal dynamic imaging,and to guide clinical diagnosis and treatment to improve prognosis.Methods:Forty-eight postoperative patients with aortic dissection who underwent 99mTc-DTPA renal dynamic imaging from March 8,2018 to July 19,2019 in the Nuclear Medicine Department of Beijing Anzhen Hospital were enrolled in this study to evaluate the renal function include perfusion,glomerular filtration rate(GFR)and bilateral upper urinary tract drainage.The difference of total renal function and left and right renal function as well as blood creatinine,urea nitrogen and uric acid were compared between aortic dissection type A and B.Results:There was no significant difference in age between the two groups.The total glomerular filtration rate of postoperative patients with aortic dissection type B was lower than that of aortic dissection type A patients(67.5 vs.80.6 m L/min,P<0.05).And the impaired left renal function was more common in postoperative patients with aortic dissection type B.The left glomerular filtration rate of aortic dissection type B postoperative patients was lower than that of type A(30.9 vs.40.3 m L/min,P<0.05).Renal dynamic imaging can also early detect unilateral impaired renal function in aortic dissection,whose overall renal function would be normal.Conclusions:99mTc-DTPA renal dynamic imaging plays an important role in the early evaluation of renal function in postoperative patients with aortic dissection.The patients with aortic dissection type B are more likely to suffer from GFR decline.In the course of diagnosis and treatment of aortic dissection,attention should be paid to the protection of renal function to improve prognosis.