^99mTc-DTPA肾动态显像及β2-m水平在评价肾移植受者肾功能中的价值

目的：探讨^99mTc-DTPA肾动态显像半定量参数和血、尿β2-m水平测定对肾移植术后早期并发症诊断与鉴别诊断的价值。方法：28例肾移植病人术后均进行放射性核素^99mTc-DTPA肾动态显像,同时测定移植肾的肾小球滤过率（GFR）、膀胱放射性计数与移植肾放射性计数比值（B/K值）和移植肾放射性1min计数与腹主动脉放射性1min计数比值（K1min/A1min比值）。在进行放射性核素肾动态显像前所有病人均收集其血液和尿液标本,采用放射免疫分析测定血、尿β2-m水平。结果：12例肾功能正常者肾动态显像示肾血流灌注及功能良好,GFR值为（49.1±6.1）ml/min,B/K值均〉3,K1min/A1min比值为8.18±1.41;4例急性排斥反应者肾血流灌注受损程度重于功能相,GFR值为（33.2±5.3）ml/min,B/K值均〈1,K1min/A1min比值为2.59±0.86,β2-m水平以血β2-m升高明显;8例慢性排斥反应者肾血流灌注和功能相均同时受损,GFR值为（19.8±7.5）ml/min,B/K值均〈1,K1min/A1min比值为2.19±0.84,β2-m水平也以血中升高明显;2例肾小管坏死者及2例环孢素A肾中毒者肾血流灌注受损均轻于功能相,GFR值分别为（38.5±4.1）ml/min和（39.4±5.81）ml/min,B/K值均〈1,K1min/A1min比值分别为5.83±0.84和6.01±0.66,β2-m水平以尿中升高显著。结论：放射性核素肾动态显像半定量参数K1min/A1min比值和B/K值,结合肾移植病人术后血、尿β2-m水平联合分析可早期初步鉴别排斥反应的类别,可作为判断移植肾受损程度、原因及预后估测的敏感指标。

Clinical Value of Dynamic 99mTc-DTPA Renography Combined with Serum and Urinary β2-m Levels Determination for Assessment of Renal Allograft Function in the Recipients

Objective To explore the diagnostic and differential diagnostic value of combined determination of the semi - quanti- tave parameters of dynamic ^99mTc - DTPA renography with serum and urinary β2-m levels for functional assessment and early detection of complications of renal allografts in the recipients. Methods Dynamic ^99mTc - DTPA renography （ lpie/lsec for bosec then lpid 30sec for 20min） with determination of the semi - quntitive parameters GFR, one minute renal uptnake/abdominal aortic uptake ratio （K1min/A1min 20 minute bladder uptake/renal uptake ratio （B/u ratio） combined with serum and urinary β2-m （with R/A） levels measurement were performed in 28 renal allograft recipients. Results In the 12 recipients with excellent renal function, both perfusion and functional phase of renography were normal with GFR 49.1±6. 1ml/min, BK ratio 〉3 and K1min/A1min ratio 8.18 ±1.41. In 4 recipients with acute rejection, the GFR was 33.2±5.3ml/min, BK ratio〈 1 K1min/A1min ratio （2.59±0.86） with significant increase of serum β2 -m. In the 8 recipients with chronie rejection, readings of the parameters were even lower： GFR 19.8＋7.5/ml/min, BK ratio〈1, and K1min/A1min ratio 2.19±0.84, with signifieant elevation of serum β2-m levels. In two recipients with acute tubular necrosis （ATN） and 2 recipients with cyclosporin A toxicity, the perfusion was better maintained （ GFR 38.5±4.1/ml/min and 39.4±5.8/ml/min respectively, BK ratio 〈 1 and K1min/A1min ratio 5.83±0.84 and 6.01±0.66 respectively） with significantly increased urinary β2-m levels. Conclusion Dynanie 99mTc - DTPA renography was very useful for early dection of renal functional impairement in the recipients and especially useful for the differential diagnosis between rejection and other conditions （e. g. ATN and drug toxicity）.