同机CT肾脏深度校正在肾积水患者99Tc^m-DTPA肾动态显像GFR测定中的价值

Integrated CT renal depth correction for the GFR determination in the 99Tcm-DTPA renal dynamic imaging of patients with hydronephrosis

目的探讨同机CT肾脏深度校正在肾积水患者99Tc^m-二乙撑三胺五乙酸(DTPA)肾动态显像测定肾小球滤过率(GFR)中的应用价值。方法回顾性分析2016年4月至2019年6月间清华大学附属北京清华长庚医院338例不同程度肾积水患者[男191例,女147例,年龄(49.6±14.5)岁],据双侧肾积水程度分为单-轻、单-中、单-重、轻-轻、轻-中、轻-重、中-中、中-重和重-重组。采用同机CT法和常规法分别测量肾脏深度,计算单-轻、单-中和单-重组患者双侧肾脏深度差的绝对值。基于同机CT法和常规法测得的肾脏深度,运用99Tc^m-DTPA肾动态显像Gates法测定分肾GFR并进行比较;将2种方法测得的总GFR与估算GFR(eGFR)进行比较。采用单因素方差分析、配对t检验、Pearson相关分析处理数据。结果在同机CT测量中,单-轻、单-中和单-重组双侧肾脏深度差绝对值的差异有统计学意义[(0.39±0.24)、(1.16±0.65)和(1.00±0.90)cm;F=15.241,P<0.05]。对于正常、轻度、中度和重度积水肾,同机CT法测得的肾脏深度及分肾GFR均大于常规法对应结果(t值:16.06~19.78和14.27~17.23,均P<0.05)。在各分组中,常规法测得的总GFR与eGFR差异均有统计学意义(t值:-8.178~5.879,均P<0.05);而同机CT法除中-重组与重-重组高估总GFR外(t值:3.035和11.247,均P<0.05),单-轻、单-中、单-重、轻-轻、轻-中、轻-重和中-中组测得的总GFR[(111.57±17.37)、(103.71±15.22)、(79.79±12.62)、(100.33±18.49)、(100.28±15.43)、(84.09±20.72)和(74.14±14.57)ml·min^-1·1.73 m^-2]与eGFR[(109.16±12.81)、(103.20±13.26)、(78.60±14.12)、(100.98±15.20)、(99.89±14.05)、(84.61±20.24)和(73.44±14.57)ml·min^-1·1.73 m^-2]的差异均无统计学意义(t值:-0.301~1.948,均P>0.05)。对于338例肾积水患者,2种方法测得的总GFR与eGFR相关(r值:0.888、0.928,均P<0.01)。结论较常规法,同机CT肾脏深度校正对于除中-重组与重-重组外的肾积水患者的99Tc^m-DTPA肾动态显像GFR测定更有临床意义。

Objective To investigate the application value of renal depth correction by the integrated CT in glomerular filtration rate(GFR)determination by 99Tc^m-diethylene triamine pentoacetic acid(DTPA)renal dynamic imaging for patients with hydronephrosis.Methods A total of 338 patients(191 males,147 females,age(49.6±14.5)years)in Beijing Tsinghua Changgung Hospital from April 2016 to June 2019 with different degrees of hydronephrosis were respectively analyzed.Patients were divided into groups of normal-mild,normal-moderate,normal-heavy,mild-mild,mild-moderate,mild-heavy,moderate-moderate,moderate-heavy and heavy-heavy according to the degree of bilateral hydronephrosis.The renal depth was measured by the integrated CT method and the routine method,and the absolute value of bilateral renal depth difference in normal-mild,normal-moderate and normal-heavy groups was calculated by the 2 methods.Based on the renal depth measured by the 2 methods,the single renal GFR was measured by 99Tc^m-DTPA dynamic renal imaging Gates method and compared between the 2 methods.Total GFR measured by the 2 methods were compared with estimated GFR(eGFR).One-way analysis of variance analysis,paired t test,and Pearson correlation analysis were used.Results For the integrated CT measurements,the absolute value of bilateral renal depth difference in normal-mild,normal-moderate and normal-heavy groups were significantly different((0.39±0.24),(1.16±0.65)and(1.00±0.90)cm;F=15.241,P<0.05).The renal depth and the single renal GFR measured by the integrated CT method were higher than those measured by the routine method(t values:16.06-19.78,14.27-17.23,all P<0.05)in the kidneys with normal,mild,moderate and heavy hydronephrosis.There were significant differences between the total GFR measured by the routine method and eGFR in all groups(t values:from-8.178 to 5.879,all P<0.05);however,in the integrated CT method,except that the total GFRs in moderate-heavy group and heavy-heavy group were overestimated(t values:3.035 and 11.247,both P<0.05),there were no significant differences between the total GFR((111.57±17.37),(103.71±15.22),(79.79±12.62),(100.33±18.49),(100.28±15.43),(84.09±20.72)and(74.14±14.57)ml·min^-1·1.73 m^-2)and eGFR((109.16±12.81),(103.20±13.26),(78.60±14.12),(100.98±15.20),(99.89±14.05),(84.61±20.24)and(73.44±14.57)ml·min^-1·1.73 m^-2)in normal-mild,normal-moderate,normal-heavy,mild-mild,mild-moderate,mild-heavy and moderate-moderate groups(t values:from-0.301 to 1.948,all P>0.05).The total GFR measured by the 2 methods were significantly correlated with eGFR in 338 patients with hydronephrosis(r values:0.888 and 0.928,both P<0.01).Conclusion Compared with the routine method,except for the moderate-heavy group and heavy-heavy group,renal depth correction by the integrated CT may have greater clinical significance in GFR measurement by renal dynamic imaging for patients with hydronephrosis.