CAJ | 학술논문

目的探讨在~(99m)Tc-DTPA肾动态显像测定肾小球滤过率(GFR)过程中是否有影响GFR准确性的因素存在,以确保诊断的准确性.方法对326例患者及1例健康志愿者应用~(99m)Tc-DTPA肾动态显像测定GFR.健康志愿者首次检查在饮水500 ml后5 min进行;第2次检查按常规在饮水500ml后30 min进行.结合肾功能曲线和GFR对检测结果进行分析.结果注射放射性的有效剂量与实测剂量不符导致GFR误差共61例,发生率为18.7%(61/326).在该类患者中有88.5%(54/61)的病例是由于注射点有放射性药物外渗所致.有8.2%(5/61)的病例因袖口过紧导致放射性药物存留在袖口压迫点的远端并缓慢释放.有3.3%(2/61)病例在测量空针筒时没有采集注射器针帽内漏出的放射性,GFR减低.饮水后短时间内注射放射性药物,导致肾功能曲线峰值减低,排泄段抬高,GFR减低.65例糖尿病患者GFR异常增高,而肾功能曲线形态表现为正常.结论 GFR的影响因素较多.综合分析肾功能曲线与GFR值,对于发现误差,确保结果的准确性具有重要意义.再密切结合病史和肾脏影像,可以进一步确保诊断的准确性.
목적 탐토재~(99m)Tc-DTPA신동태현상측정신소구려과솔(GFR)과정중시부유영향GFR준학성적인소존재,이학보진단적준학성.방법 대326례환자급1례건강지원자응용~(99m)Tc-DTPA신동태현상측정GFR.건강지원자수차검사재음수500 ml후5 min진행;제2차검사안상규재음수500ml후30 min진행.결합신공능곡선화GFR대검측결과진행분석.결과 주사방사성적유효제량여실측제량불부도치GFR오차공61례,발생솔위18.7%(61/326).재해류환자중유88.5%(54/61)적병례시유우주사점유방사성약물외삼소치.유8.2%(5/61)적병례인수구과긴도치방사성약물존류재수구압박점적원단병완만석방.유3.3%(2/61)병례재측량공침통시몰유채집주사기침모내루출적방사성,GFR감저.음수후단시간내주사방사성약물,도치신공능곡선봉치감저,배설단태고,GFR감저.65례당뇨병환자GFR이상증고,이신공능곡선형태표현위정상.결론 GFR적영향인소교다.종합분석신공능곡선여GFR치,대우발현오차,학보결과적준학성구유중요의의.재밀절결합병사화신장영상,가이진일보학보진단적준학성.
Objective To explore the possible factors influencing the accuracy of glomerular filatration rate (GFR) measurement by ~(99m)Tc-DTPA dynamic renal imaging.Methods Three hundred and twenty six patients and one healthy volunteer underwent ~(99m)c-DTPA dynamic renal imaging to measure GFR.The patients received 500 ml fluid at 30 to 60 minutes before the examination.For the volunteer, 500 ml fluid was given at 5 minutes before the first examination and at 30 minutes before the second examination.The GFRs were calculated using Gates method.The final results were analyzed combined with renogram and GFR.Results Errors in GFR measurement due to unmatched doses of radioactive contrast used and detected were indicated in 61 patients (18.7%), among which, radioactive leakage at the sites of injection was found in 88.5% (54/61) and radioactive retention distally to a tight sleeve was found in 8.2% (5/61). The radioactivity counts of syringe cover were ignored in 2 patients (3.3%), leading to lowered GFR readings.Injection of radioactive agent shortly after fluid-drinking was associated with lowered maximal counts of the curves, elevated excretory phase of the renogram, and thus reduced GFR.The GFR increased abnormally in 65 patients with diabetes, but the renograms curves were normal.Conclusions GFR measurement may be affected by a number of factors.Comprehensive analysis of GFR and renograms is important to ensure the accuracy of tests.Adding patient's history and kidney imaging study would further improve the diagnostic accuracy.