肾小球滤过率与肌酐清除率的差值鉴别急性和慢性肾衰

目的探讨用放射性核素肾动态显像测的肾小球滤过率（GFR）与肌酐清除率（Ccr）的差值能否鉴剐急性肾衰和慢性肾衰。方法主要通过肾脏病理区分急性肾衰和慢性肾衰。共研究63例患者，59例患者行肾活检检查，4例未行肾活检患者为临床上典型的慢性肾衰病人。采用自身对照的研究方法，用^99mTc-DTPA肾动态显像测定急性肾衰33例和慢性肾衰30例的GFR，其中急性肾衰病因为急性肾小管坏死和急性小管间质性肾炎15例、狼疮性肾炎1例、急进性肾炎17例；慢性肾衰病因为慢性肾炎25例，慢性间质性肾炎1例，高血压肾病2例，糖尿病肾病2例。同时也用血肌酐估算患者的肌酐清除率，比较急、慢性肾衰这两个数差值的变异。结果急性肾衰组和慢性肾衰组患者的血清肌酐（Scr）和GFR均无明显的差异，但其自身GFR（18．8±13．97ml／min）与Ccr（10．78±12．46ml／min）的差值有显著性差异（P〈0．05）。进一步把急性肾衰分为小管性急性肾衰和小球性急性肾衰，小管性急性肾衰组与小球性急性肾衰和慢性肾衰的Scr和GFR间差异也不大（P〉0．05），不过小管性急性肾衰的GFR—Ccr明显高于小球性急性肾衰（P〈0．001）和慢性肾衰（P〈0．05），数值分别为（25．09±13．46）ml／min，（13．56±12．41）ml／min，（10．78±12．46）ml／min，而在小球性急性肾衰与慢性肾衰间这个差值无显著意K（P〉0．05）。结论放射性核素肾动态显像可用于小管性急性肾衰与小球性急性肾衰及慢性肾衰的鉴别，尤其是其自身的GFR与Ccr的差值大于25ml／min，多为小管性急性肾衰。

Clinical significance of GFR-Ccr difference value in differential diagnosis of patients with AFR and CRF

Objective To investigate the clinical significance of differences of glomerular filtration rate (GFR) and creatine clearance rate (Ccr)in differential diagnosis of patients with acute renal failure (ARF)and chronic renal failure (CRF). Methods First,63 Patients in Department of Nephrology,Hainan Province People's Hospital,were enrolled in present study and 33 definitely diagnosised as ARF cases and 30 CRF cases,59 patients were undergone renal-biopsy and the other 4 patients with CRF were not. Self-controll...