用单血浆法预测双血浆法99mTc-二乙三胺五乙酸血浆清除率

目的:寻找单血浆法(SPSM)测定肾小球滤过率(GFR)的适用条件,并用SPSM预测双血浆法(DPSM)的GFR结果.方法:选择近两年来在我院就诊的慢性肾脏病(CKD)患者335例,男192例,女143例,平均年龄(51.91±14.76)岁.同时用SPSM及DPSM测定99mTc-二乙三胺五乙酸(DTPA)血浆清除率,以DPSM血浆清除率(tGFR)为参考标准,对不同SPSM血浆清除率(sGFR)进行比较,开发出用sGFR预测tGFR的方程.用简化MDRD公式估计GFR(aGFR),阐明SPSM替代DPSM的时机.结果:当tGFR ≥ 30 mL/(min·1.73 m2)时,sGFR与tGFR呈高度相关,以Watson 改良的Christensen and Groth's公式表现最好(r=0.977,P<0.001),预测方程为tGFR mL/(min·1.73 m2)]=7.755 4 0.789 3×sGFR 0.002 4×sGFR2.aGFR小于50 mL/(min·1.73 m2)时诊断tGFR<30 mL/(min·1.73 m2)的敏感性为94.7%.结论:当aGFR ≥ 50 mL/(min·1.73 m2)时, 可用SPSM替代DPSM.

Comparison of single plasma sample methods and prediction of dual plasma sample method in measurement of 99mTc-Diethylene Triamine Pentaacetic Acid plasma clearance

OBJECTIVE: To find an applicable condition of the single-plasma-sample method (SPSM) to measure the glomerular filtration(GFR) with (99m)Tcj Diethylene Triamine Pentaacetic Acid ((99m)Tc-DTPA), and predict the value of (99m)Tc-DTPA plasma clearance by dual plasma sample method (DPSM ) from that by SPSM. METHODS: Three hundred and thirty five patients with chronic kidney disease (CKD) were selected (192 males and 143 females). The average age was 51.91+/-14.76 years. The GFR was determined simultaneously by 2 methods: (1) SPSM (sGFR); (2) DPSM (tGFR), using DPSM as reference standard, sGFR calculated from the different SPSM was compared with tGFR. An equation was developed to predict tGFR from sGFR. GFR estimated by abbreviated Modification of Diet in Renal Disease (MDRD) equation (aGFR) was evaluated as the criterion in selection of DPSM and SPSM. The condition that DPSM could be substituted by SPSM in GFR measurement was given. RESULTS: When tGFR >or= 30 mL/(minx1.73 m(2)), all of the sGFR were significantly correlated with tGFR. Among them, Watson modified Christensen and Groth's equation at sample time=240 min tended to be the most accurate (r=0.977, RMSE=10.91), and tGFR could be predicted from sGFR using the equation: Predicted tGFR mL/(minx1.73 m(2))]=7.755 4+0.789 3xsGFR+0.002 4 xsGFR2 (n=297, r2=0.959 1, P<0.001). When aGFR was less than 50 mL/(minx1.73 m(2)), the diagnostic sensitivity of tGFR<30 mL/(minx1.73 m(2)) was 94.7%, and recommended as the criterion in selection of DPSM and SPSM. CONCLUSION: When aGFR >or=50 mL/(minx1.73 m(2)), DPSM can be substituted by SPSM in GFR measurement.