中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2008年
4期
282-286
,共5页
杜晓英%朱阳军%李林法%何强%陈江华
杜曉英%硃暘軍%李林法%何彊%陳江華
두효영%주양군%리림법%하강%진강화
本底辐射%放射性同位素肾图术%肾小球滤过率%感性区间
本底輻射%放射性同位素腎圖術%腎小毬濾過率%感性區間
본저복사%방사성동위소신도술%신소구려과솔%감성구간
Background radiation%Renography%Glomeru]ar fihration rate%Region of interest
目的 以99mTc-DTPA血浆清除率为标准,评价在重度肾功能不全[GFR≤30 ml·min-1·(1.73 m2)-1]患者GFR的评估中,本底矫正在提高99mTc-DTPA肾动态显像检查准确性中的价值.方法 选择重度慢性肾脏病患者33例,年龄均＞20岁,男性/女性=13/20,平均Scr334 μmol/L,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、肢体缺如及心功能不全.分别检测患者身高、体质量.常规99mTc-DTPA肾动态功能显像,采用双肾下极(传统Gates法,a法)及肾周环形勾画法(b法)获取图像本底,并分别由计算机自动计算GFR值(GFRa和GFRb).于注射后2 h、4 h各抽血4 ml,离心后取血浆1 ml,测量其放射性计数.计算99mTc-DTPA的血浆清除率(双血浆法,GFRp)作为GFR标准.所测数值均用体表面积标准化.肾动态显像两种不同方法求得的GFRa和GFRb值分别与99mTc-DTPA的血浆清除率进行比较.结果 两种方法,即Gates法、肾周环形本底法,所得的GFR测量值与99mTc-DTPA的血浆清除率(GFRp)比较:相关系数(ra、rb)分别为0.602、0.834;偏差中位数分别为8.33、-4.41;绝对偏差中位数分别为8.33、4.49.GFRa和GFRb落在GFRp±15%、±30%和±50%范围内的病例百分数分别为24.2%、30.3%和48.5%及33.3%、51.5%和81.8%.结论 在重度肾功能不全患者肾小球滤过率的评估中,传统的Gates法明显高估了患者实际的GFR值,而肾周环形本底的选取能明显提高传统Gates法的准确性,可能具有临床推广的价值.
目的 以99mTc-DTPA血漿清除率為標準,評價在重度腎功能不全[GFR≤30 ml·min-1·(1.73 m2)-1]患者GFR的評估中,本底矯正在提高99mTc-DTPA腎動態顯像檢查準確性中的價值.方法 選擇重度慢性腎髒病患者33例,年齡均＞20歲,男性/女性=13/20,平均Scr334 μmol/L,診斷均符閤美國NKF-K/DOQI關于慢性腎髒病定義.排除腎功能急性噁化因素、水腫、肢體缺如及心功能不全.分彆檢測患者身高、體質量.常規99mTc-DTPA腎動態功能顯像,採用雙腎下極(傳統Gates法,a法)及腎週環形勾畫法(b法)穫取圖像本底,併分彆由計算機自動計算GFR值(GFRa和GFRb).于註射後2 h、4 h各抽血4 ml,離心後取血漿1 ml,測量其放射性計數.計算99mTc-DTPA的血漿清除率(雙血漿法,GFRp)作為GFR標準.所測數值均用體錶麵積標準化.腎動態顯像兩種不同方法求得的GFRa和GFRb值分彆與99mTc-DTPA的血漿清除率進行比較.結果 兩種方法,即Gates法、腎週環形本底法,所得的GFR測量值與99mTc-DTPA的血漿清除率(GFRp)比較:相關繫數(ra、rb)分彆為0.602、0.834;偏差中位數分彆為8.33、-4.41;絕對偏差中位數分彆為8.33、4.49.GFRa和GFRb落在GFRp±15%、±30%和±50%範圍內的病例百分數分彆為24.2%、30.3%和48.5%及33.3%、51.5%和81.8%.結論 在重度腎功能不全患者腎小毬濾過率的評估中,傳統的Gates法明顯高估瞭患者實際的GFR值,而腎週環形本底的選取能明顯提高傳統Gates法的準確性,可能具有臨床推廣的價值.
목적 이99mTc-DTPA혈장청제솔위표준,평개재중도신공능불전[GFR≤30 ml·min-1·(1.73 m2)-1]환자GFR적평고중,본저교정재제고99mTc-DTPA신동태현상검사준학성중적개치.방법 선택중도만성신장병환자33례,년령균＞20세,남성/녀성=13/20,평균Scr334 μmol/L,진단균부합미국NKF-K/DOQI관우만성신장병정의.배제신공능급성악화인소、수종、지체결여급심공능불전.분별검측환자신고、체질량.상규99mTc-DTPA신동태공능현상,채용쌍신하겁(전통Gates법,a법)급신주배형구화법(b법)획취도상본저,병분별유계산궤자동계산GFR치(GFRa화GFRb).우주사후2 h、4 h각추혈4 ml,리심후취혈장1 ml,측량기방사성계수.계산99mTc-DTPA적혈장청제솔(쌍혈장법,GFRp)작위GFR표준.소측수치균용체표면적표준화.신동태현상량충불동방법구득적GFRa화GFRb치분별여99mTc-DTPA적혈장청제솔진행비교.결과 량충방법,즉Gates법、신주배형본저법,소득적GFR측량치여99mTc-DTPA적혈장청제솔(GFRp)비교:상관계수(ra、rb)분별위0.602、0.834;편차중위수분별위8.33、-4.41;절대편차중위수분별위8.33、4.49.GFRa화GFRb락재GFRp±15%、±30%화±50%범위내적병례백분수분별위24.2%、30.3%화48.5%급33.3%、51.5%화81.8%.결론 재중도신공능불전환자신소구려과솔적평고중,전통적Gates법명현고고료환자실제적GFR치,이신주배형본저적선취능명현제고전통Gates법적준학성,가능구유림상추엄적개치.
Objective To evaluate the improvement of diagnostic accuracy with background region of interest(ROI)rectification for 99mTc-DTPA renography in patients with GFR≤plasma sampling method). Methods Thirty-three patients(age＞20 years,male/female=13/20)dose of 111 MBq/0.5 ml of 99mTc-DTPA was injected into an antecubital vein.The background ROI was selected below the kidney(Gates method,method a)or around the kidney(method b),then these two different GFR(GFRa,GFRb)were automatically estimated by computer.Meanwhile,3 ml blood samples were collected 2 h and 4 h after injection respectively,and radioactivity of 1 ml plasma was measured.GFR was calculated by dual plasma sampling method(GFRp)and the results were all standardized with the body surface area.The accuracies and correlations of GFRa and GFRb were compared to GFRp respectively. Results The correlation coefficients were ra=0.602 and rb=0.834.The median of difference of GFRa and GFRb was 8.33,-4.41.The median of absolute difference of GFRa and GFRb was 8.33,4.49.The accuracies within±15%,±30%and±50%of GFRa were 24.2%,30.3%and 48.5%,and those of GFRb were 33.3%,51.5%and 81.8%.Conclusion The background ROI around kidney can obviously improve the diagnostic accuracy of 99mTc-DTPA renography in patients with severe renal insufficiency.
