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1.
董华  张遵城  董萍  张悦  张帆  王国强 《山东医药》2011,51(20):77-78
目的探讨核素99mTc-DTPA肾动态显像在重度肾积水患肾残余功能及手术疗效评价中的临床价值。方法回顾性分析57例经超声检查诊断为重度肾积水患者手术前后的99mTc-DTPA肾动态显像结果,包括肾脏影像、患肾肾小球滤过率(GFR)及肾图曲线,所有患者术前静脉肾盂造影(IVP)患肾均不显影。结果所有病例的术前99mTc-DTPA肾动态显像显示患肾有残余功能,术后患肾放射性摄取功能较术前增加,手术前后GFR分别为(12.6±3.5)、(29.5±14.0)m l/m in,P〈0.05。结论 99mTc-DTPA肾动态显像是评价重度肾积水患肾残余功能的理想方法,且能准确反映手术疗效和疾病转归。  相似文献   

2.
目的 探讨99mTc-DTPA肾动态显像评价水化治疗预防对比剂致肾功能损伤的价值.方法 选择17例接受冠状动脉造影(CAG)检查的肾功能不全代偿期患者,入选患者术前12 h开始水化治疗,按照1~1.5 ml/(kg·h)输入生理盐水和5%NaHCO3注射液(125 ml),术后继续维持生理盐水输入12 h.CAG前24 h、后72 h分别行99mTc-DTPA肾动态显像,测定肾小球滤过率(GFR),同时测定血清尿素氮(BUN)、血清肌酐(Scr)进行对比分析.结果 17例患者术后双肾GFR、血BUN、Scr水平,与造影前比较,差异均无统计学意义(P均>0.05).结论 99mTc-DTPA肾动态显像进一步证实了水化治疗预防对比剂导致肾功能损伤的有效性.  相似文献   

3.
目的探讨利用99m Tc-DTPA肾动态显像肾小球滤过率(GFR)指标对成功进行经皮腔内肾动脉支架置入术(PTRAS)治疗的单侧脉粥样硬化性肾动脉狭窄(ARAS)患者的疗效。方法成功进行PTRAS治疗的单侧ARAS患者,在进行PTRAS治疗前2周及术后6个月进行99m TDTPA肾动态显像;根据患者肾动脉造影狭窄程度,狭窄程度50%~69%为轻度组(24例),70%~89%为中度组(25例)及≥90%为重度组(38例);根据GFR测定结果将患者分为三级:GFR≥30 ml/min为1级;15~30 ml/min为2级;GRF15 ml/min为3级;通过比较ARAS患者治疗前后GFR与血压变化情况,分析其对PTRAS疗效的评价作用。结果肾动脉造影结果显示,轻度和中度组GFR显著高于重度组(t=-2.510,P=0.007);术后1级和2级患者的高血压改善率显著高于3级患者(P0.005);Logistics回归分析显示,肾功能分级是影响患者血压改善的唯一影响因素(OR=1.623,P=0.021)。结论 99m Tc-DTPA肾动态显像可以客观评价单侧ARAS患者PTRAS术后患肾GFR变化,并可预测术后血压改善情况,具有重要价值。  相似文献   

4.
将68例2型糖尿病(T2DM)患者根据尿蛋白排泄率分为三组,即正常尿蛋白组、微量蛋白尿组、临床蛋白尿组,将其肾动态显像与14例健康人(对照组)比较,比较肾小球滤过率(GFR)、肾功能曲线峰时20min残留率(C20)。结果正常尿蛋白组GFR及肾有效血浆流量(ERPF)明显高于对照组(P均〈0.01);微量蛋白尿组GFR、ERPF与对照组比较无显著差异,但半排时间(T1/2)延长(P〈0.05);C20增高(P〈0.05)。临床蛋白尿组GFR、ERPF进一步降低(P〈0.01),肾功能曲线峰时(Tp)进一步后延(P〈0.01),T1/2进一步延长(P〈0.01),20min残留率(C20)增加更明显(P〈0.01)。提示^99mTc-DTPA肾动态显像可早期了解糖尿病患者肾脏受损程度,为临床治疗和随访提供依据。  相似文献   

5.
核素肾动态显像对老年2型糖尿病患者肾功能的研究   总被引:1,自引:0,他引:1  
目的了解老年2型糖尿病(DM)患者不同病程阶段肾脏血流动力学变化及肾功能受损情况.方法将50例2型糖尿病患者根据尿白蛋白排泄率(UAER)分为3组(1)DM正常白蛋白尿组(DM1组)10例,UAER<20μg*min-1.(2)DM微量白蛋白尿组(DM2组)20例,UAER20~200μg*min-1.(3)DM临床蛋白尿组(DM3组)20例,UAER>200μg*min-1.与20例正常对照组(NC组)一起进行99mTc-DTPA(99mTc-二乙三胺五乙酸)和99mTc-EC(99mTC-半胱氨酸)肾动态显像.结果DM1组肾小球滤过率(GFR)和肾有效血流量(ERPF)明显高于NC组(P<0.01).DM2组GFR,ERPF与NC组相比无差异,但其99mTc-EC测定的肾功能曲线半排时间(T1/2)延长(P<0.01),20min残留率(C20)增高(P<0.05).DM3组GFR、ERPF明显下降(P<0.01),肾功能曲线峰时间(Tp)后延(P<0.05),T1/2更加延长(P<0.01),C20更加增多(P<0.01).结论核素肾动态显像可早期诊断老年2型糖尿病肾病,并了解肾功能受损程度,其程度随病程的延长而加重.  相似文献   

6.
目的评价胱抑素C(CysC)公式、MDRD简化公式及Cockcroft-Gault公式对老年、老老年住院患者肾功能不全的诊断价值。方法连续收集具有99mTc-DTPA肾动态显像、CysC、血肌酐(SCr)等完整数据资料住院老年患者158例。根据99mTc-DTPA肾动态显像检测结果将患者分为5个等级,采用CysC公式、MDRD简化公式及Cockcroft-Gault公式采用公式分别计算推测肾小球滤过率(GFRCysC、GFRMDRD及GFRG-C)。结果99mTc-DTPA肾动态显像结果显示144例患者出现肾功能损害(GFR90 ml/min)。ROC曲线分析显示:CysC公式曲线下面积大于其他2个公式,老年患者曲线下面积GFRCysC0.924、GFRMDRD0.894、GFRG-C0.0.897,老老年患者曲线下面积GFRCysC0.916、GFRMDRD0.897、GFRG-C0.903。Pearson相关分析显示:在老年及老老年患者中各计算公式计算的GFR与99mTc-DTPA肾动态显像、CysC、血清肌酐、GFRCysC、GFRMDRD及GFRG-C显著相关(P0.05)。一致性检验:老年患者三种计算公式Kappa系数分别为GFRCysC0.564、GFRMDRD0.558、GFRG-C0.456(P0.01),老老年患者中,三者Kappa系数分别为GFRCysC0.486、GFRMDRD0.412、GFRG-C0.388(P0.01)。结论采用血清CysC公式、MDRD简化公式、Cockcroft-Gault公式计算的GFR是评价老年、老老年住院患者肾功能损害的敏感和可靠的指标,但CysC公式优于其他2种公式。  相似文献   

7.
目的 探讨99mTc-DTPA肾动态显像判断糖尿病肾病(DN)患者肾功能的临床价值,为临床诊治T2DM及预后判断提供相关依据.方法 选取39例T2DM患者,并根据尿微量清蛋白测定结果 分成正常清蛋白尿组(11例)和清蛋白尿组(28例),另选择同期健康者12例作为对照组.受试者均行核素肾动态显像获取肾小球滤过率(GFR)及肾功能曲线,同时测定尿清蛋白水平.结果 正常清蛋白尿组GFR值与对照组比较,差异有统计学意义(P<0.05);清蛋白尿组GFR值与对照组比较,差异有统计学意义(P<0.01);清蛋白尿组尿清蛋白水平与对照组比较,差异有统计学意义(P<0.05).结论 核素肾动态显像可用于早期诊断T2DM,了解双肾功能的受损程度,为治疗方案的选择提供一定依据.  相似文献   

8.
目的:应用99mTc-DTPA肾动脉显像评价Stanford不同分型主动脉夹层患者术后左、右侧肾功能及总体肾功能受损程度,帮助临床制定进一步的治疗方案,改善患者预后。方法:回顾性分析2018年3月8日至2019年7月19日,在本院核医学科行99mTc-DTPA肾动态显像的主动脉夹层术后患者48例,评价患者双肾血流灌注、总肾小球滤过率(GFR)和分肾的GFR,比较Stanford主动脉夹层A型(简称A型)患者和主动脉夹层B型(简称B型)患者之间总肾功能及分肾功能,血肌酐、血尿素氮及血尿酸水平的差异。结果:B型患者术后总GFR低于A型患者(67.5 vs.80.6 m L/min,P<0.05),其中以左肾功能受损为著(30.9 vs.40.3 m L/min,P<0.05),差异有统计学意义。结论:肾动态显像对主动脉夹层术后患者早期评价肾功能有重要价值。主动脉夹层B型患者GFR较A型减低,且左侧肾GFR减低更明显,临床可以早期采取干预措施,改善主动脉夹层患者预后。  相似文献   

9.
目的 探讨肾功能临床相关指标对小儿先天性肾积水的诊断价值。方法 用 99m Tc- DTPA核素动态显像测定 6 8只患肾和 14只正常肾的肾小球滤过率 (GFR) ,并与年龄及临床常规血检的血清尿素氮(BU N)、血清肌酐 (SCr)、血红蛋白 (Hb)进行相关性分析。结果  GFR与正常儿童年龄呈正相关 (r=0 .4 2 8,P<0 .0 5 ) ;中、重度肾积水患儿 GFR与 Hb呈正相关 (分别为 r=0 .341、P<0 .0 5 ,r=0 .6 35、P<0 .0 1) ;GFR与 BU N只在重度肾积水呈负相关 (r=- 0 .5 5 9,P<0 .0 5 ) ;GFR与 SCr呈显著负相关 (r=- 0 .4 4 5 ,P<0 .0 1) ;中、重度肾积水肾功能显著性下降 (P<0 .0 5 ,P<0 .0 0 1) ,轻度积水肾与正常肾肾功能无显著性差异 (P<0 .0 5 )。结论 GFR与 SCr是检测小儿先天性肾积水肾功能的理想指标 ;BU N不适于肾积水的早期诊断 ;临床诊断明确的小儿先天性肾积水应早期手术治疗 ,以防止肾功能下降至失代偿而造成局部和全身性损害。  相似文献   

10.
目的探讨肾动态显像肾血流灌注指数(PI)评价肾功能的价值。方法选取151例慢性肾病患者,于肘静脉"弹丸"式注射99Tc(锝)m-DTPA 111MBq/0.3~0.5 mL后即刻行肾动态图像采集,计算PI、肾小球滤过率(GFR),根据GFR判定肾功能。显像后1周内采患者空腹静脉血3 mL,采用全自动生化分析仪测定血清Cr和BUN水平。对PI与GFR及SCr、BUN的关系行直线相关分析。选择肾损害早期肾脏60个,记录PI与GFR。结果双肾轻度受损(A组)48例、中度受损(B组)53例、重度受损(C组)50例。A、B、C三组PI、血清SCr、BUN依次升高,GFR依次降低,P均<0.01。A、B组PI与GFR均呈明显负相关,与SCr、BUN均呈明显正相关,C组PI与GFR无明显相关性,与SCr、BUN均呈明显正相关。肾损害早期肾脏60个,PI升高者占13.3%(8/60),GFR降低者占65%(39/60),GFR降低率明显高于PI升高率P<0.01(χ2=33.09)。结论慢性肾病患者的PI与肾功能受损密切相关;其可作为评估肾功能的一项客观指标,在肾功能重度受损时PI优于GFR。  相似文献   

11.
149例慢性肾衰患者血脂水平及其与肾功能的相关性   总被引:1,自引:0,他引:1  
目的探讨血脂水平对慢性肾衰患者肾功能的影响。方法检测149例慢性肾衰患者(观察组)和30例健康献血者(对照组)血脂[TG、TC、HDL—C、LDL—C、血肌酐(SCr)]水平,并分析上述指标与肾小球滤过率(GFR)的相关性。结果观察组TG、TC轻度升高,HDL—C明显下降,LDL—C明显升高。GFR与TG、TC无明显相关性,而与HDL-C水平呈明显正相关(r=0.21,P〈0.05),与LDL—C水平呈显著负相关(r=-0.29,P〈0.01)。结论慢性肾衰患者存在明显的血脂代谢异常;其可能是加快肾脏功能损伤的重要危险因素。  相似文献   

12.
目的探讨尿白蛋白与肌酐比值(UACR)和肾小球滤过率(GFR)联合诊断在糖尿病肾脏病变评估中的临床意义。方法分析294例住院糖尿病患者的资料,行99mTC-DTPA肾小球滤过率和UACR检查。结果正常白蛋白尿、微量白蛋白尿及大量白蛋白尿患者中分别有9.6%(15/157)、25.3%(23/91)、45.7%(21/46)出现了GFR的下降;以UACR为标准诊断糖尿病患者肾损害的灵敏度、特异度分别为88.9%、59.3%,以GFR为标准其灵敏度、特异度分别为80.6%、88.8%,而联合UACR与GFR诊断其灵敏度、特异度分别为94.4%、54.3%;结论UACR正常的糖尿病患者已有部分出现肾功能下降,联合GFR有助于更好地评价糖尿病患者的肾脏病变情况。  相似文献   

13.
目的探讨同型半胱氨酸(Hcy)、血清胱抑素C(Cys-c)与高血压早期肾损害的相关性。方法:收集我院2011年6月~2013年7月符合入选标准的153例高血压病患者,用同位素肾图检查作为金标准测定肾小球滤过率(GFR),按照GFR数值分成两组:肾功能正常组和肾功能受损组。同时测定每组血清Hcy、Cys-C和24 h尿微量白蛋白(24h MAU)、血肌酐及尿素氮,比较两组之间是否有差异,最后对GFR与Cys-C及Hcy进行相关性分析。结果:肾功能无损害组与肾功能损害组Hcy、Cys-C比较差异有统计学意义(P〈0.05,P〈0.01)。Pearson相关分析显示,GFR与Hcy、Cys-C和尿素氮及肌酐呈负相关(均P〈0.01)。多元线性回归分析显示:Hcy、Cys-C是影响GFR的独立危险因素,其标准偏回归系数13值分别为-2.015(P〈0.05)、-5.448(P〈0.01)。结论:Hcy、Cys-C与原发性高血压早期肾损害有相关性。  相似文献   

14.
冠心病患者肾功能与冠状动脉病变程度的关系   总被引:2,自引:1,他引:1       下载免费PDF全文
目的 探讨冠心病患者肾功能与冠状动脉病变程度的关系.方法 根据基础肾小球滤过率(GFR)将连续299例接受冠状动脉造影患者分为3组:肾功能正常组144例,GFR〉90 ml/(min×1.73m2);肾功能轻度减退组97例,GFR 60~89ml/(min×1.73 m2);肾功能中度减退组58例,GFR〈60ml/(min×1.73 m2);再分别根据入院检查的尿常规(0、微量、1+、2+、3+)将患者分为2组:尿蛋白阴性组171例,尿蛋白阳性组128例,比较各组间的临床特点及冠状动脉病变情况.结果 随着肾功能减退及蛋白尿的产生,冠心病发生率(66.7%、70.1%和72.4%,P〈0.05,64.2%和75.0%,P〈0.05)增高,多支血管病变明显增多,冠状动脉病变积分[(15.0+14.7)、(19.0±20.0)和(22.0±21.2),(15.2±16.0)和(20.4±20.2)]增高.结论 慢性肾功能减退及蛋白尿是冠状动脉病变的危险因素,尤其在肾脏受损的早期蛋白尿检查更加重要.  相似文献   

15.
The effects of percutaneous transluminal renal angioplasty (PTRA) on the renal function of stenotic kidneys are usually assessed by evaluating the changes in serum creatinine, which is quite a rough indicator of glomerular filtration rate (GFR). In 27 hypertensive patients with 19 atherosclerotic and 11 fibromuscular significant renal artery stenoses, we investigated with renal scintigraphy the short-term (5 days) and long-term (10 months) effects of a technically successful PTRA (in seven cases combined with a stent implantation) on GFR of the stenotic and contralateral kidneys; these measurements were combined with those of plasma renin activity (PRA) and of angiotensin II (AII). We found that in short-term studies after PTRA GFR rose from 29.7 +/- 3.5 to 34.6 +/- 3.1 mL/min and from 36.9 +/- 4.0 to 45.1 +/- 4.3 mL/min, respectively, in atherosclerotic and fibromuscular poststenotic kidneys. In long-term studies GFR further and significantly increased, to 37.8 +/- 3.2 mL/min in the former group, whereas it stabilized in the latter group (46.0 +/- 3.6 mL/min). In patients with fibromuscular stenosis these changes in GFR were associated with clear-cut reductions in blood pressure (BP), PRA, and AII; these decrements also occurred in patients with atherosclerotic stenosis but to a much lesser extent. We also found that in short- and long-term studies the percent of PTRA-induced increments of GFR in the poststenotic kidneys were inversely correlated with the baseline values of GFR. In addition, the absolute and percent increments of GFR were positively correlated with the basal levels of AII. Thus the time course of the improvement in GFR after angioplasty may differ in kidneys, depending on the etiology of the stenosis, in that in those with fibromuscular stenosis it was entirely apparent within a few days whereas in those with atherosclerotic stenosis it required several months to be fully expressed. Also, it appears that the more compromised kidneys are those that benefit most from the dilatation and that AII levels are useful indicators of the possibility that the stenotic kidney will have a favorable functional outcome in terms of restoration of renal blood flow.  相似文献   

16.
目的:观察冠心病患者经皮冠状动脉腔内介入治疗术(PCI)后对比剂所致肾损伤时尿中性粒细胞明胶酶脂质运载蛋白(NGAL)的变化。方法:选择105例术前肾功能正常的行PCI术的冠心病患者,检测其手术前后不同时间点血肌酐(Scr)、尿NGAL水平和肾小球滤过率(GFR)。结果:术后有11例患者诊断为对比剂肾损伤,其尿NGAL水平异常较Scr提前至少24h。术后12h尿NGALROC曲线得出ROC曲线下的面积为0.824,AUC95%的可信区间为(0.735,0.913)。单变量分析示术前NGAL水平与GFR呈负相关,与年龄、血Scr浓度、血糖水平及糖尿病患病时间、血压水平及高血压患病时间呈正相关;术后尿NGAL水平与GFR呈负相关,与血Scr、手术时间呈正相关;多元Logistic回归分析显示血Scr及GFR是NGAL水平的独立影响因子。结论:尿NGAL对于冠心病患者PCI术后发生早期肾损伤具有良好的预测作用。  相似文献   

17.
血清胱抑素C在系统性红斑狼疮患者肾功能检测中的价值   总被引:1,自引:0,他引:1  
目的探讨血清胱抑素C(CysC)在系统性红斑狼疮(SLE)患者肾功能检测中的价值。方法研究对象为78例SLE患者(观察组)、67例健康体检者(对照组);采用乳胶颗粒增强散射免疫比浊法测定血清CysC、β2-微球蛋白(β2-MG),酶法测定血清肌酐(SCr)、尿素氮(BUN)。结果与对照组比较,观察组肾小球滤过率(GFR)〉80mL/(min·1.73 m^2 )者血清CysC、BUN、SCr、β2-MG无显著差异;GFR40~80ml/(min·1.73 m^2 )者仅血清CysC明显升高(P〈0.01);GFR〈40ml/(min·1.73 m^2 )者血清CysC显著升高(P〈0.001),BUN、SCr、β2-MG亦明显升高(P〈0.01)。结论血清CysC是反映肾小球滤过功能的指标,较BUN、SCr、β2-MG更敏感,可作为SLE患者肾损害的早期诊断指标之一。  相似文献   

18.
Bilateral kidney damage in hypertensive patients is not parallel. Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), as a commonly used antihypertensive drug, could protect kidney function and delay its deterioration. Most studies focused on overall renal function, but the researches on split renal function (SRF) are rare. We investigated the effects of ACEI/ARB on the SRF in patients with primary hypertension.Patients with primary hypertension (n = 429; male: 213; female: 216) admitted to our department between January 2014 and December 2016 were included in this study. The glomerular filtration rate (GFR) of split and total renal function were determined using diethylenetriaminepentaacetic acid tagged with 99mTc renal dynamic imaging method. For the same patient, the side with high GFR was considered as higher GFR kidney, whereas that with a low GFR was considered as lower GFR kidney. The split function score (Q value) was utilized to evaluate the differences of bilateral renal function. The patients were divided into 3 groups based on the Q values (Group 1, Q value <5%; Group 2, Q value of 5%–10%; Group 3, Q value ≥10%). All the patients received antihypertensive therapy based on ACEI/ARB. The renal dynamic imaging was performed in the 1-year follow-up to investigate the changes of the SRF.Compared with the baseline level, significant decline was noticed in the serum creatinine (Scr) in Group 2 and Group 3 (P < .05). The cystatin C in Group 3 showed significant decline (P < .05). Compared with the baseline, there was significant decline in the Q value in Group 2, whereas the GFR of lower GFR kidney showed significant increase (P < .05). No statistical differences were noticed in the Q value and split GFR in Group 1 and Group 3 (P > .05).In primary hypertension patients, ACEI/ARB therapy could improve the SRF of lower GFR kidney in the presence of certain differences between the SRF. As a result, the SRF difference was reduced. In case of Q value in a range of 5% to 10%, ACEI/ARB could improve the renal function effectively. It may be significant for the design of antihypertensive drugs.  相似文献   

19.
In anaesthetized cats reversible denervation of one kidney was performed by cooling of the left renal nerves to 3 degrees C for 16 min. The response of the left (ipsilateral) kidney was compared with the response of the right (contralateral) kidney twice in the same animal: (1) when the right kidney was still innervated, and (2) after it had been surgically denervated. Left renal nerve cooling did not cause any changes in arterial pressure. In the left kidney, blood flow, vascular conductance, sodium and water excretions increased, and renin release decreased. Simultaneously in the contralateral kidney, no haemodynamic changes were observed, glomerular filtration was only transiently decreased, whereas sodium and water excretion significantly decreased and renin release increased. When left renal nerve cooling was repeated after surgical denervation of the right kidney, similar changes were observed in the left (ipsilateral) kidney, whereas all contralateral effects were abolished. These experiments suggest that tonically active afferent fibres from one kidney exert a reflex inhibitory action on sympathetic activity directed to the contralateral kidney controlling tubular sodium reabsorption and renin release.  相似文献   

20.
目的 :探讨肾动脉纤维肌性发育不良(FMD)所致肾血管性高血压的临床特点、介入治疗及预后情况。方法:纳入2009—2013年我科收治的FMD所致肾血管性高血压患者共22例,均进行了经皮肾动脉介入治疗,回顾分析患者的临床特点,评价并随访其介入治疗的疗效及预后。结果:22例患者平均年龄(25±5)岁,其中女性16例(72.7%)。介入治疗采用单纯球囊扩张术18例(81.8%),行肾动脉支架植入术4例(18.2%)。患者平均诊室血压由术前(163±22)/(101±15)mm Hg(1 mm Hg=0.133 k Pa)下降至(122±15)/(80±10)mm Hg。其中12例(54.5%)治愈,10例(45.5%)血压得到改善,降压有效率为100%。术前患者血清肌酐水平为(75±25)μmol/L,术后为(74±21)μmol/L,无统计学差异(P=0.69);其中有8例患者行核素99m锝肾小球滤过率(99m Tc-GFR)随访,显示患侧肾脏99m Tc-GFR由术前(25.2±4.8)m L/min上升至(39.4±8.2)m L/min,术后有明显改善(P=0.001)。随访发现2例(9.1%)患者出现了再狭窄,并再次施行了球囊扩张术,术后血压得到了改善。结论:FMD患者经皮肾动脉成型术降压安全、有效,并能改善患侧肾功能,可作为临床首选治疗方法。  相似文献   

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