^(99)Tc^m-DTPA肾动态显像评价新生儿肾积水肾功能

Assessment of renal function with ^(99)Tc^m-DTPA renal dynamic imaging in neonatal hydronephrosis

目的 探讨用99Tcm DTPA肾动态显像评价新生儿肾积水肾功能的价值。方法 用99Tcm DTPA肾动态显像测定 15例患儿 18只患肾和 12只正常肾的肾小球滤过率 (GFR) ,与同期血尿素氮(BUN)、血清肌酐 (SCr)、血红蛋白 (Hb)结果进行相关分析。结果 ①中、重度新生儿肾积水GFR与Hb呈正相关 (r=0 4 14、0 6 6 7,P <0 0 5、<0 0 1)。②GFR与BUN无相关性。③中、重度新生儿肾积水GFR与SCr呈显著负相关 (r=- 0 4 90、- 0 75 6 ,P <0 0 5、<0 0 1)。④轻度新生儿肾积水相对肾功能与正常肾比较差异无显著性 (P >0 0 5 ) ;中度新生儿肾积水相对肾功能 [(38 91± 8 70 ) % ]在4 0 %以下 ,重度新生儿肾积水 [(2 9 2 3± 7 37) % ]在 30 %以下 ,与正常肾比较 ,中、重度新生儿肾积水相对肾功能均明显下降 (P <0 0 5、<0 0 1)。结论 99Tcm DTPA肾动态显像测定GFR是检测新生儿肾积水肾功能的理想指标。SCr可作为肾功能损害的检测指标 ,尤其对中、重度新生儿肾积水。BUN不适于诊断新生儿肾积水。临床诊断明确的中、重度新生儿肾积水应早期手术治疗 ,以防肾功能进一步损害。

Objective To assess the renal function in neonatal hydronephrosis with 99 Tc m-DTPA renal imaging. Methods Eighteen unilateral hydronephrotic kidneys and 12 normal kidneys were studied by 99 Tc m-DTPA renal dynamic imaging,and glomerular filtration rate (GFR) quantitative analysis was also performed. Blood urea nitrogen (BUN),serum creatinine (SCr) and hemoglobin (Hb) were determined simultaneously and the correlations betweem GFR and each of these parameters were analyzed. Results ①Positive correlation was discovered between GFR and Hb in neonates with moderate or severe hydronephrosis ( r =0.414,0.667,P <0.05,<0.01,respectively) and showed significant statistical difference. ②There was no correlation between GFR and BUN in neonatal hydronephrosis. ③GFR was negatively correlated with SCr ( r =-0.490,-0.756,P <0.05,<0.01,respectively) in neonates with moderate or severe hydronephrosis. ④There was no significant difference of GFR between mild neonatal hydronephrosis and normal kidneys ( P >0.05). The renal function was decreased significantly in moderate and severe neonatal hydronephrosis ( P<0.05,<0.01,respectively). Conclusions 99 Tc m-DTPA renal dynamic imaging GFR is an ideal marker for estimating renal function in neonatal hydronephrosis;SCr could be a marker for renal damage especially in moderate and severe neonatal hydronephrosis;BUN could not be a marker for evaluating renal function in neonatal hydronephrosis. Neonates with hydronephrosis should be referred for surgical procedures as soon as possible in the early stage.