影像法评估肾小球滤过率的研究进展

Research progress of imaging methods to evaluate the glomerular filtration rate

肾小球滤过率(glomerular filtration rate, GFR)是评估肾功能的关键临床指标,也是急慢性肾病定义和分期的基础。在临床实践中,GFR评估主要基于血清肌酐值、尿素氮的经验转换,但敏感度较低,不足以诊断亚临床或临界状态的肾功能衰竭,也不能评估单侧肾功能,而临床迫切需要一种既可快速准确评估GFR,又能提供详细肾解剖结构的无创检查方法,以避免早期肾损伤的漏诊。近年研究表明,计算机断层扫描尿路造影、结合深度学习法自动分割技术的定量单光子发射计算机断层显像-电子计算机X射线断层扫描及磁共振尿路成像等技术对快速、客观全面评估GFR有很大价值,未来可能成为临床GFR评估的主要影像学手段。本文综述近年来影像法评估GFR的改良进展并分析新技术的优点及不足。

The glomerular filtration rate(GFR) is important in the evaluation of renal clinical indicators, and it is the basis for the definition and staging of chronic kidney disease. In clinical practice, GFR assessment is mainly based on empirical conversion of the serum creatinine value and urea nitrogen, but the sensitivity is low, which is insufficient to diagnose subclinical and critical stage renal failure, cannot evaluate single renal functions. Therefore, there is an urgent need for a non-invasive examination method that quickly and accurately assesses GFR and provides detailed kidney anatomy to avoid a missed diagnosis of early kidney injury. Recent studies have shown that quantitative single-photon emission computed tomography/computed tomography combined with a deep learning automatic segmentation technique, magnetic resonance urography, one-stop computational tomography urography has a great potential for rapid, and comprehensive evaluation of GFR, which may become the main imaging method for clinical GFR evaluation in the future. This article reviews the traditional GFR evaluation method and summarizes the improvement of GFR evaluation in recent years as well as the advantages and disadvantages of new technology analysis.