肾移植术后患者基于肾动态显像法的肾小球滤过率的临床价值评估

摘要:通过基于美国核医学学会推荐为临床上测定GFR的金标准的99mTc-DTPA的双血浆法测量肾小球滤过率，肾动态显像法所得GFR与其比较，探讨肾动态显像法在肾移植后肾功能中的应用诊断价值。方法：使用基于99mTc-DTPA的双血浆法测量从2018年9月到2019年6月的108例肾移植患者的肾小球滤过率，通过gate法估计GRF，比较测得的GFR与双血浆法测得的GFR的相关性、准确度，评估ECT法的检验性能。结果：双血浆法测得GFR平均值为63.47 ml/(min*1.732)，SPECT法测得GFR平均值为72.55 ml/(min*1.732)，偏倚为9.08 ml/(min*1.732)。具有显著的相关性（r=0.703，P<0.0001）。在总体中患者的GFR偏移较大，因而行亚组分析，将病人按GFR高低分为高GFR组、低GFR组以及按性别分为男性组、女性组进行亚组分析，比较各亚组测得的GFR的检验性能。各亚组比较偏移最小的组为高GFR组，最大的组为低GFR组。准确度方面一般取P30作为参考，高GFR组的准确度为82.54%，具有最高的准确率，低GFR组的准确度仅为55.56 %。男女性分组间无明显差异。结论：肾动态显像法测量GFR的总体准确性尚可，得出的GFR总体偏大，各亚组分析后也存在较大偏移。但在高GFR组中的所测得的GFR准确较高，可以通过所得GFR公式的改进，获得较好的GFR结果，低GFR组测得数据准确度不够，仍需使用双血浆法。

Evaluation of clinical value of glomerular filtration rate based on renal dynamic imaging in patients after renal transplantation

Abstract: The glomerular filtration rate was measured by the double plasma method based on the 99mTc-DTPA recommended by the American Academy of Nuclear Medicine as the gold standard for clinical determination of GFR. GFR obtained by renal dynamic imaging was compared with this method for diagnostic value of renal function after renal transplantation. Methods: The 99mTc-DTPA-based double plasma method was used to measure the glomerular filtration rate of 108 kidney transplant patients from September 2018 to June 2019. The GRF was estimated by the gate method, and the measured GFR and double plasma were compared. Correlation and accuracy of GFR measured by the method, to evaluate the inspection performance of the ECT method. Results: The average GFR measured by the double plasma method was 63.47 ml / (min * 1.732), the average GFR measured by the SPECT method was 72.55 ml / (min * 1.732), and the bias was 9.08 ml / (min * 1.732). There was a significant correlation (r = 0.703, P <0.0001). The overall GFR shift of the patients is large, so a subgroup analysis is performed. The patients are divided into high GFR groups, low GFR groups according to the high and low GFR levels, and divided into male and female groups by gender. Inspection performance of measured GFR. The group with the smallest comparison shift in each subgroup was the high GFR group, and the largest group was the low GFR group. In terms of accuracy, P30 is generally used as a reference. The accuracy of the high GFR group is 82.54%, which has the highest accuracy rate. The accuracy of the low GFR group is only 55.56%. There was no significant difference between male and female groups. Conclusion: The overall accuracy of renal dynamic imaging to measure GFR is acceptable, and the GFR obtained is generally large, and there is also a large deviation after analysis of each subgroup. However, the measured GFR in the high GFR group is more accurate, and a better GFR result can be obtained by improving the obtained GFR formula and the accuracy of the measured data in the low GFR group is not sufficient. The double plasma method should be used in the low GFR group.