单侧单发肾癌患者术前分肾GFR的测定与分析

Measurement and analysis of split GFR in patients with a single unilateral renal cancer preoperatively

目的分析核素肾动态显像Gate's法测定的单侧单发肾癌患者总肾、患肾及健肾肾小球滤过率(GFR)的特点。方法收集2018年1月至2019年12月于天津医科大学第二医院就诊的50例单侧单发肾癌患者(肾癌组)[其中男性32例、女性18例,年龄43~65(54.2±9.7)岁]的术前临床资料,并以中国肾癌高发年龄段(47~68岁)的60名健康受试者[其中男性36名、女性24名,年龄(56.1±8.6)岁]为对照组进行回顾性研究。肾癌组患者术前与对照组同期均行^(99)Tc^(m)-二亚乙基三胺五乙酸(DTPA)肾动态显像,比较2组受试者的临床指标、总肾及单肾GFR。肾癌组总肾GFR与对照组总肾GFR,肾癌组患肾、健肾GFR与对照组单肾GFR的比较均采用独立样本t检验。观察肾癌组患者中非对称肾功能的发生情况和健肾代偿情况,比较慢性肾脏病学流行病学合作研究公式和Gate's法计算肾癌组总肾GFR的差异,并采用Pearson相关性分析进行分析。结果肾癌组与对照组的性别比、年龄、吸烟情况、体重指数、血压、空腹血糖、动脉粥样硬化指数、血红蛋白、血清肌酐、尿素和尿酸等各项临床指标的差异均无统计学意义(χ^(2)=0.185、0.021,t=0.656~1.980,均P>0.05)。肾癌组患者总肾GFR[(103.9±15.9)mL/min]与对照组[(103.2±10.6)mL/min]相比,差异无统计学意义(t=0.116,P=0.908)。与对照组单肾GFR[(51.2±5.9)mL/min]相比,肾癌组患肾GFR[(47.4±13.0)mL/min]明显降低,健肾GFR[(56.1±10.9)mL/min]明显升高,且差异均有统计学意义(t=−2.248、2.837,均P<0.05)。50例肾癌患者中,21例患者患肾与健肾GFR占总肾GFR的百分比之差的绝对值>10%;16例患者健肾GFR高于同年龄段健康人群单肾GFR参考值范围的上限。慢性肾脏病学流行病学合作研究公式和Gate's法分别计算肾癌组总肾GFR的差异有统计学意义[(120.1±26.1)mL/(min·1.73 m^(2))vs.(108.7±13.4)mL/(min·1.73 m^(2)),t=3.765,P<0.05]且二者具有相关性(r=0.54,P<0.05)。结论核素肾动态显像Gate's法可获得患肾和健肾GFR变化的准确信息,为肾癌患者治疗方案的确定提供依据。

Objective To analyze the characteristics of total glomerular filtration rate(GFR)and single GFR measured by Gate's method for radionuclide renal dynamic imaging measured by Gate's method for radionuclide renal dynamic imaging in patients with single unilateral renal cancer and to provide relevant information for clinical therapy.Methods A total of 50 patients(including 32 males and 18 females,age 43–65(54.2±9.7)years)with single unilateral renal cell cancer(renal cancer group)were collected from the Second Hospital of Tianjin Medical University from January 2018 to December 2019,and 60 healthy adults(36 males and 24 females,age 47–68(56.1±8.6)years)with high incidence age of renal cancer in China were selected as the control group to conduct a retrospective study.^(99)Tc^(m)-diethylenetriaminepentaacetic acid(DTPA)renal dynamic imaging was performed in the renal cancer and control groups at the same time.The clinical data,total GFR,and split GFR of both groups were compared.Independent sample t-test was used to compare the total GFR and split GFR in both groups.To observe the incidence of asymmetric renal function and renal compensation in patients with renal cancer,the difference of total GFR calculated using the chronic kidney disease epidemiology collaboration equation and Gate's method in the renal cancer group was compared,and correlation analysis was performed using Pearson's correlation analysis.Results No significant difference was observed in gender ratio,age,smoking status,body mass index,blood pressure,blood glucose,atherosclerosis index,hemoglobin,serum creatinine,urea,and uric acid in both groups(χ^(2)=0.185,0.021,t=0.656–1.980,all P>0.05).No significant difference was observed in the total GFR in both groups((103.9±15.9)mL/min vs.(103.2±10.6)mL/min,t=0.116,P=0.908).Compared with the single kidney GFR of the control group((51.2±5.9)mL/min),GFR of tumor-lateral renal((47.4±13.0)mL/min)was significantly decreased,GFR of contra-lateral normal renal(56.1±10.9)mL/min was significantly increased,and the differences were statistically significant(t=−2.248,2.837;both P<0.05).The absolute value of the percentage difference between GFR in split kidney and total kidney was greater than 10%in 21 of the 50 patients.In 16 patients,the GFR of contralateral normal renal was higher than the superior limit of the reference range of split kidney GFR in healthy people of the same age.The difference between the two methods(chronic kidney disease epidemiology collaboration equation and Gate's method)in the total GFR of renal cancer group was statistically significant((120.1±26.1)mL/(min·1.73 m^(2))vs.(108.7±13.4)mL/(min·1.73 m^(2)),t=3.765,P<0.05)and they were correlated(r=0.54,P<0.05).Conclusion ^(99)Tc^(m)-DTPA renal dynamic imaging preoperatively can obtain accurate information about the GFR of the kidney,which has significant value for the decisionmaking of therapeutic regimen.