99mTc-DTPA肾动态显像检测肾小球滤过率的临床应用评价

目的 以^99mTc-DTPA血浆清除率为标准，评价^99mTc-DTPA肾动态显像检查在检测肾小球滤过率(GFR)中的应用价值。方法 选择慢性肾脏病患者197例，年龄均>18岁，诊断均符合美国NKF-K/DOQI关于慢性肾脏病定义。排除肾功能急性恶化因素、水肿、肢体缺如、心功能不全。记录身高、体重。肘静脉“弹丸”式注射^99mTc-DTPA 111 MBq后即刻行肾动态图像采集120 帧，计算双肾GFR，即Gates法，同时于注射后2、4 h各抽血4 ml，分离血浆1 ml，测量其放射性计数，计算99mTc-DTPA的血浆清除率(双血浆法)，所测数值均用体表面积标准化。按双血浆法所测得的GFR值将患者分成3组:A组 77例，GFR < 30 ml·min^-1·(1.73 m²)^-1；B组 74例， 30 ml·min^-1·(1.73 m²)^-1≤GFR < 90 ml·min^-1·(1.73 m²)^-1；C组 46例，GFR≥90 ml·min^-1·(1.73 m²)^-1。分别行肾动态显像法与双血浆法所测值之间的相关分析。 结果 肾动态显像法及双血浆法所测3组GFR[单位:ml·min^-1·(1.73 m²)^-1]分别为:A组 (27.08±12.14) 比 (17.68±5.66)；B组 (63.18±23.59) 比 (51.95±16.81)； C组 (107.28±27.36) 比 (117.96±24.17)。2者间的相关系数分别为rA=0.286(P=0.012)；rB=0.804(P < 0.01)；rC=0.473(P < 0.01)。结论 99mTc-DTPA肾动态显像检查适用于轻、中度肾功能不全患者GFR的评估，但在重度肾功能不全患者中，其测量结果的准确性有待进一步提高。

Evaluation of the application of 99mTc-DTPA renography (Gates method) in the determination of glomerular filtration rate in clinical practice

Objective To evaluate the application of 99mTc-DTPA renography in the determination of GFR. Methods One hundred and ninety-seven patients with primary or secondary chronic kidney disease participated in this study. A 3 mci(111 MBq)/0.5 ml dose of 99mTc-DTPA was injected as a bolus in an antecubital vein. Renal scintigraphic images were collected immediately and the images were processed according to standard procedure (Gates method)to obtain GFR. Four ml of blood was withdrawn 2 h and 4 h postinjection respectively and radioactivity of 1 ml plasma was measured. GFR was calculated by the formula of two-sample method. The results by two methods were all standardized with the body surface. The patients were divided into three subgroups according to the GFR obtained by two-sample method and the correlation between two methods was analysed respectively. Results The GFR[ml&;#8226;min-1&;#8226;(1.73 m2)-1]obtained from Gates method and two-sample method was displayed as follows:group A: 27.08±12.14 vs. 17.68±5.66； group B: 63.18±23.59 vs. 51.95±16.81； group C: 107.28±27.36 vs. 117.96±24.17. The correlation coefficients of three subgroups were as follows: rA=0.286(P = 0.012)； rB=0.804(P < 0.01)； rC=0.473(P < 0.01). Conclusion Gates method is acceptable for evaluating the GFR in patients with normal to moderately diminished renal function， but it is less precise in those with severe renal insufficiency.