| 肾动态显像评价肾积水患者肾功能的应用价值 |
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| 引用本文： | 王若楠,司宏伟,张雅蓉,张克慧,李思进. 肾动态显像评价肾积水患者肾功能的应用价值[J]. 国际放射医学核医学杂志, 2019, 43(2): 145-151. DOI: 10.3760/cma.j.issn.1673-4114.2019.02.009 |
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| 作者姓名： | 王若楠 司宏伟 张雅蓉 张克慧 李思进 |
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| 作者单位： | 1.山西医科大学第一医院核医学科，太原 030001;2.安徽医科大学第一附属医院核医学科，合肥 230022 |
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| 摘 要： | 目的 探讨肾动态显像Gates法测定肾小球滤过率（GFR）（gGFR）在肾积水和非肾积水肾病中的应用价值。 方法 选取2015年1月至2017年1月同时接受双血浆法测定GFR（rGFR）和gGFR的肾积水患者和非肾积水肾病患者，肾积水患者191例，其中男性97例、女性94例，年龄（43.35±15.91）岁；非肾积水肾病患者133例，其中男性82例、女性51例，年龄（55.31±13.54）岁。参照美国慢性肾脏病及透析的临床实践指南，将肾积水患者和非肾积水肾病患者分别分为肾功能正常组和轻、中、重度慢性肾衰竭组，对每组gGFR和rGFR进行分析比较，并计算两种方法的差值（ΔGFR）。不同肾功能组的比较采用单因素方差分析（ANOVA），若差异有统计学意义，则行LSD-t检验法进行两两比较。gGFR和rGFR的比较采用配对t检验；相关性采用Pearson相关分析；一致性分析用Bland-Altman检验。 结果 肾积水和非肾积水肾病患者的gGFR比rGFR高，且前者的差异有统计学意义[（70.60±22.58） mL/（1.73 m2·min） vs. （58.67±20.49） mL/（1.73 m2·min），t=9.335，P=0.000]；与非肾积水肾病患者比较，肾积水患者gGFR和rGFR的相关性（r=0.692，P=0.000）较低。在肾积水患者中，轻、中、重度慢性肾衰竭组的gGFR均明显高于rGFR[（81.01±18.40） mL/（1.73 m2·min） vs. （71.03±7.74） mL/（1.73 m2·min）、（60.98±18.28） mL/（1.73 m2·min） vs. （45.85±7.60） mL/（1.73 m2·min）、（42.88±16.14） mL/（1.73 m2·min） vs. （23.65±4.04） mL/（1.73 m2·min）]，差异均有统计学意义（t=4.559、8.398、4.480，均P<0.05）；中度慢性肾衰竭组gGFR和rGFR的相关性（r=0.461，P=0.000）最高；肾功能正常组和轻、中、重度慢性肾衰竭组患者的ΔGFR逐渐增高，分别为（−1.61±14.05）、（9.99±18.81）、（15.14±16.54）、（19.23±15.48）mL/（1.73 m2·min），差异有统计学意义（F=5.595，P=0.001）； 有5.76%（11/191，>5%）的点在一致性界限（LOA）之外，gGFR和rGFR的一致性较差。在非肾积水肾病患者中，轻度慢性肾衰竭组的gGFR明显低于rGFR[（66.08±8.97） mL/（1.73 m2·min） vs. （70.59±8.08） mL/（1.73 m2·min）]，差异有统计学意义（t=−3.472，P<0.05），中、重度慢性肾衰竭组的gGFR高于rGFR[（45.99±9.76） mL/（1.73 m2·min） vs. （43.83±8.29） mL/（1.73 m2·min）、（26.25±8.57） mL/（1.73 m2·min）vs.（20.19±5.72） mL/（1.73 m2·min）]，差异均有统计学意义（t=2.095、4.907，均P<0.05）；轻度慢性肾衰竭组gGFR和rGFR的相关性（r=0.737，P=0.000）最高；肾功能正常组和轻、中、重度慢性肾衰竭组患者的ΔGFR逐渐增高，分别为（−5.64±16.64）、（−4.51±6.23）、（2.16±7.71）、（6.06±6.87）mL/（1.73 m2·min），差异有统计学意义（F=9.446，P=0.000）；有3.01%（4/133，<5%）的点在LOA之外，gGFR和rGFR的一致性较好。 结论 肾动态显像Gates法评估肾积水患者的GFR价值有限，应参考双血浆法的定量结果和其他检查结果进行综合分析判断。
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| 关 键 词： | 肾盂积水 肾小球滤过率 肾动态显像 双血浆法 |
| 收稿时间： | 2018-09-25 |
Evaluation of the application value of dynamic renal scintigraphy in patients with hydronephrosis |
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| Ruonan Wang,Hongwei Si,Yarong Zhang,Kehui Zhang,Sijin Li. Evaluation of the application value of dynamic renal scintigraphy in patients with hydronephrosis[J]. International Journal of Radiation Medicine and Nuclear Medicine, 2019, 43(2): 145-151. DOI: 10.3760/cma.j.issn.1673-4114.2019.02.009 |
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| Authors: | Ruonan Wang Hongwei Si Yarong Zhang Kehui Zhang Sijin Li |
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| Affiliation: | 1. Department of Nuclear Medicine, the First Hospital of Shanxi Medical University, Taiyuan 030001, China;2. Department of Nuclear Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China |
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| Abstract: | Objective To explore the application value of dynamic renal scintigraphy glomerular filtration rate (GFR) (gGFR) in patients with and without hydronephrosis. Methods A total of 191 patients with hydronephrosis (97 men and 94 women, aged 43.35±15.91 years) and without hydronephrosis (82 men and 51 women, aged 55.31±13.54 years) who underwent plasma GFR (rGFR) and gGFR examinations from January 2015 to January 2017 were involved in this study. They were divided into normal, mild, moderate, and severe renal damage group in accordance with the renal function stratification of the guidelines of National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Each group of gGFR and rGFR was analysed and compared, and the difference in the two methods was calculated. The bias of the two measurements among the groups was examined through one-way ANOVA. If statistical differences were observed, LSD-t test was used. Differences, correlation, and agreement between gGFR and rGFR were evaluated through a paired t-test, Pearson correlation coefficients, and Bland–Altman plots, respectively. Results gGFR was higher than rGFR in patients with and without hydronephrosis, but a significant difference was detected in patients with hydronephrosis only [(70.60±22.58) mL/(1.73 m2·min) vs. (58.67±20.49) mL/(1.73 m2·min), t=9.335, P=0.000]. The correlation coefficients between gGFR and rGFR were lower in patients with hydronephrosis than in patients without hydronephrosis. In the patients with hydronephrosis, gGFR was significantly higher than rGFR in the mild, moderate, and severe renal damage groups [(81.01±18.40) mL/(1.73 m2·min) vs. (71.03±7.74) mL/(1.73 m2·min), (60.98±18.28) mL/(1.73 m2·min) vs. (45.85±7.60) mL/(1.73 m2·min), and (42.88±16.14) mL/(1.73 m2·min) vs. (23.65±4.04) mL/(1.73 m2·min)] with significant differences(t=4.559, 8.398, 4.480, both P<0.05). Their correlation coefficients were the highest in the moderate renal damage group(r=0.461). ΔGFR of the normal, mild, moderate, and severe renal damage groups sequentially increased [(−1.61±14.05), (9.99±18.81), (15.14±16.54), and (19.23±15.48) mL/(1.73 m2·min), respectively)] with significant differences (F=5.595, P=0.001). The Bland–Altman plots revealed 5.76% (11/191, >5%) scatter points outside the consistency limit (LOA), and their consistency in patients with hydronephrosis was unsatisfactory. In patients without hydronephrosis, gGFR was significantly lower than rGFR in the mild renal damage group [(66.08±8.97) mL/(1.73 m2·min) vs. (70.59±8.08) mL/(1.73 m2·min)] but was higher in the moderate and severe renal damage groups [(45.99±9.76) mL/(1.73 m2·min) vs. (43.83±8.29) mL/(1.73 m2·min), (26.25±8.57) mL/(1.73 m2·min) vs. (20.19±5.72) mL/(1.73 m2·min)] with significant differences (t=2.095, 4.907, both P<0.05). The correlation coefficients between gGFR and rGFR were the highest in the mild renal damage group (r=0.737, P=0.000). ΔGFR of the four groups sequentially increased [(−5.64±16.64), (−4.51±6.23), (2.16±7.71), and (6.06±6.87) mL/(1.73 m2·min), respectively) with significant differences (F=9.446, P=0.000). The Bland–Altman plots showed 3.01% (4/133, <5%) scatter points outside LOA, and the consistency in patients without hydronephrosis was good. Conclusion GFR estimated by renal scintigraphy(Gates method) should be improved for patients with hydronephrosis, and plasma-based methods might be applied to them. |
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| Keywords: | Hydronephrosis Glomerular filtration rate Renal dynamic imaging Double plasma method |
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