核素肾动态显像联合实验室检查评估含顺铂化疗患者早期肾损害临床价值

目的:探讨99mTc-二乙三胺五醋酸(99mTc-DTPA)肾动态显像联合实验室检查评估含顺铂(DDP)化疗患者早期肾功能损害的临床价值。方法:对26例非小细胞肺癌和20例胃癌首次化疗患者在化疗2周期前后分别进行99mTc-DTPA肾动态显像,测定肾小球滤过率(GFR)、高峰时间(Tb)、半排时间(C1/2),患者行肾动态显像当天(间隔不超过24h)检测血清肌酐(Scr)、尿素氮(BUN)、尿微量白蛋白(UMA)、尿β2球蛋白(β2-MG),和胱抑素C(CysC)水平。结果:双肾血流灌注峰值下降,46例患者总GFR均值化疗后为64.3毫升/分钟,较化疗前86.3毫升/分钟明显下降(P<0.05),肾摄取峰值(Tb)降低,排泄速率(C1/2)减慢(P<0.05)。46例患者Scr,BUN,UMA化疗前后差异无统计学意义(P>0.05),而β2-M,Cys C化疗前后差异有统计学意义,化疗后尿β2-M,Cys C水平较化疗前明显增高(P<0.01)。结论:核素肾动态显像能全面、早期、客观监测DDP对肾功能早期损害,GFR值、Tb、C1/2β2-MG,Cys C为评价早期肾损害的灵敏指标。

Clinical Value of Evaluating the early effect of Chemotherapy on renal function Using Radionuclide Renal Dynamic Imaging and Laboratory examination in Patients Treated With DDP

Objective:To observe the clinical value of renal dynamic imaging and laboratory examination in detecting the early changes of renal function after chemotherapy in patients treated with DDP.Methods:26 patients with non-small cell lung cancer(NSCLC) and 20 patients with gastric cancer were performed 99mTc-DTPA renal dynamic imagings before and after chemotherapy The glomerular filtration rate(GFR),the peaktime(Tb) and the half activity time(C1/2) were gained,and simultaneously,the finding was analyzed along with serum creatinine(Scr) and blood urea nitrogen(BUN),Urine micro-albumin(UMA),β2-microglobin(β2-MG),Cystatin C(Cys C).Results:GFR in 46 patients after chemotherapy was obviously decreased in comparison with that before chemotherapy(P<0.05) along with the fact that the Tb and C1/2 of the renogram significantly were prolonged(P<0.05).Statistically,there was no significant change in Scr,BUN and UMA(P>0.05).However,the results ofβ2-MG,Cys C were obviously demonstrated that there was a clearly statistic difference before and after chemotherapy.Conclusion:Renal dynamic imaging could be all-round,objective and visual to detect the early change of renal function influenced by DDP,associating withβ2-MG and Cys C which could be good supplements.