99Tcm-DTPA肾动态显像对单侧肾积水患者健侧肾代偿功能的研究

目的 探讨99Tcm-二亚乙基三胺五乙酸（99Tcm-DTPA）肾动态显像在评价单侧肾积水患者健侧肾代偿功能中的应用。 方法 回顾性分析2016年1月至2019年7月天津医科大学第二医院收治的257例单侧肾积水患者的临床资料，其中男性149例、女性108例，年龄12~87（52.84±14.23）岁。所有患者均行99Tcm-DTPA肾动态显像，并通过Gates法计算患者分肾及总的肾小球滤过率（GFR）。按照患者的肾积水程度、患肾受损程度、肾结石位置、患肾位置、性别和年龄进行分组。将各组的健侧肾与单侧肾的GFR正常值上限作比较，计算患者健侧肾的GFR的代偿率（%）。健侧肾与患侧肾的GFR的比较采用两独立样本t检验。患者健侧肾代偿能力的影响因素分析采用Mann-Whitney U 检验及Kruskal-Wallis检验。 结果 所有患者的患侧肾的GFR为（28.60±15.13） mL/min，健侧肾的GFR为（63.17±15.74） mL/min，总的GFR为（92.94±24.46） mL/min。患侧肾的GFR明显低于健侧肾的GFR，且差异有统计学意义（t=25.39，P<0.001）。患者健侧肾的GFR存在不同程度的代偿性增高，其代偿率为9.54%（?5.94%，26.45%）。患者不同年龄和患侧肾积水程度对健侧肾的GFR的代偿率有影响，且差异均有统计学意义（χ2=47.32、12.71，均P<0.01）；患侧肾受损程度、肾脏积水位置、肾结石位置和性别对健侧肾的GFR代偿率无影响，且差异均无统计学意义（χ2=4.34，Z=?0.51、?1.62、?1.41，均P>0.05）。 结论 99Tcm-DTPA肾动态显像可以更好地评估单侧肾积水患者健侧肾代偿能力，能够为单侧肾积水患者的诊治及预后评估提供依据。

Study of 99Tcm-DTPA renal dynamic imaging on the compensatory capacity of contralateral kidney in patients with unilateral hydronephrosis

Objective To investigate the application of 99Tcm-diethylene-triaminepentaaccetic acid (99Tcm-DTPA) dynamic renal imaging in evaluating the compensatory function of healthy kidneys in patients with unilateral hydronephrosis. Methods A total of 257 cases of unilateral hydronephrosis admitted to the Second Hospital of Tianjin Medical University from January 2016 to July 2019 were retrospectively analyzed. They included 149 males and 108 females, aged 12~87 (52.84±14.23) years. All patients underwent 99Tcm-DTPA renal dynamic imaging, and their glomerular filtration rate (GFR) was counted using the Gates method. They were also grouped in accordance with the degree of hydronephrosis, the degree of renal impairment, gender, age, and etiology. The GFR compensation rate (%) of the uninfected kidney in different groups was calculated. The GFR of both kidneys was compared using independent sample t-test. The influencing factors of the compensatory ability were analyzed using the Mann-Whitney U and Kruskal-Wallis tests. Results The GFR of the affected kidney was (28.60±15.13) mL/min, while that of the contralateral kidney was (63.17±15.74) mL/min, and the total GFR was (92.94±24.46) mL/min. The GFR of the affected kidney was significantly lower than that of the contralateral kidney (t=25.39, P<0.001). Varying degrees of compensatory increase were observed in the GFR of the uninfected kidney, the GFR compensation rate was 9.54% (?5.94%, 26.45%). Statistically significant differences were also found in the GFR compensation rate of the contralateral kidney among patients of different ages and degrees of hydronephrosis (χ2=47.32, 12.71, both P<0.01). No statistically significant difference was found in the GFR compensation rate of the contralateral kidney among patients with different degrees of renal damage on the affected side, the location of hydronephrosis, the location of the stones, and gender (χ2=4.34, Z=?0.51, ?1.62, ?1.41, all P>0.05). Conclusion Using renal dynamic imaging to study the factors affecting the compensatory ability of the contralateral kidney in patients with unilateral hydronephrosis could further provide a basis for the diagnosis, treatment, and prognostic evaluation of these patients.