应用肾图代谢动力学参数分析利尿剂肾图对上尿路梗阻的诊断

目的探讨用数学模型推理肾脏分泌系数与排泄系数分析利尿剂肾图,以助于上尿路梗阻的诊断。方法建立邻碘马尿酸钠(OIH)在体内代谢的数学模型,用肾图代谢动力学参数绘制典型肾图曲线,对65例病人,涉及的77侧肾盂、输尿管在标准肾图检查的基础上,行利尿剂肾图检查,对照二者的诊断准确性,并行χ2检验。结果用数理方法推理出的肾图代谢动力学参数绘制的典型肾图曲线,部分曲线在b段是相同的,但代谢动力学参数有差异。标准肾图诊断上尿路梗阻的准确性为52%,假阳性为48%,无假阴性;利尿剂肾图诊断上尿路梗阻的准确性为81%,假阳性为13%,假阴性为6%;二者相差显著(P<0.01)。结论利尿剂肾图诊断上尿路梗阻的准确性显著高于标准肾图,但仍存有假阳性与假阴性,其原因主要是由于OIH进入肾脏的速度与排出速度的比率变化所致。用肾图代谢动力学参数分析利尿剂肾图可有机地将肾脏的分泌与排泄功能结合起来观察,更新了以往肾图分析的某些概念,使肾图分析方法从静态定性转到定量分析。

Analysing the effect of uretic renogram in diagnosis of upper urethra obstruction with renogram metabolizing kinectic parameter

Objective To probe and analyse the uretic renogram with the renal secretive and excretive coefficient obtained by mathematics model.Methods The mathematics model of OIH metabolizing in body was established,and the typical renogram curves were drew with renogram metabolizing kinectic parameter.The65cases with77lateral upper urethra suspected obstruction were examined by standard renogram and uretic renogram.The diagnostic accurate rates of the2groups were compared each other withχ 2 test.Results Although some curves were same on b part in typical renogram drawn by metabolizing kinectic parameters,in fact the metabolizing kinectic parameters were different.The diagnostic accurate rate of upper urethra obstruction in standard renogram was52%,the false positive rate was48%,there was no false negative.The diagnostic accurate rate of upper urethra obstruction in uretic renogram was81%,the false positive rate was13%,the false negative rate was6%.There was significant difference between the2groups(P<0.01).Conclusion The diagnostic accurate rate of upper urethra obstruction in uretic renogram was obviously higher than that in standard renogram.There were still false positive and false negative,the reason was the ratio changing of OIH entering and coming out kidney from metabolizing kinectic parameters view.Analysing the uretic renogram with metabolizing kinectic parameters could observe the secretive and excretive function of kidney integratively,change some past concepts of renogram analysis,transfer the renogram analysis from static qualitative analysis to dynamic quantitative analysis.