本文選題：腎積水 + 腎小球?yàn)V過率��； 參考：《山西醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:以~(99m)Tc-DTPA雙血漿法GFR為參考標(biāo)準(zhǔn),評價腎積水患者~(99m)Tc-DTPA腎動態(tài)顯像Gates法、CT深度校正、CT感興趣區(qū)面積校正及深度與感興趣區(qū)面積同時校正四種方法所測總GFR值的準(zhǔn)確性。方法:共有47例腎積水患者,男性20例,女性27例,平均年齡44.53±11.62歲(21~59歲),均經(jīng)B超確診為腎積水患者,其中單側(cè)腎積水患者35例,雙側(cè)腎積水患者12例。采用常規(guī)利尿腎動態(tài)顯像,所有患者均經(jīng)肘靜脈“彈丸式”注射~(99m)Tc-DTPA(185MBq),隨后即刻行雙腎動態(tài)采集30min,于15min時注射速尿40mg。采集結(jié)束后行腎區(qū)局部CT掃描。按照儀器所帶程序處理雙腎圖像,根據(jù)Gates法獲得總腎GFR(g GFR);在CT圖像上測量雙腎深度獲得雙腎深度校正后GFR(d GFR);再在CT圖像上勾畫腎臟感興趣區(qū)面積,并將疊加后的最大腎臟面積作為CT所得腎臟面積,并依此腎臟面積大小及輪廓作為雙腎ROI,測得面積校正后的GFR(a GFR);將CT腎臟面積校正與CT腎臟深度共同校準(zhǔn)所得到的GFR為面積深度校正法GFR(ad GFR)。在注射顯像劑后第120min和240min時,于對側(cè)肘靜脈各抽取5ml血樣,離心10min后分別收集1ml血清,測量其放射性計(jì)數(shù),利用雙血漿法公式計(jì)算GFR值(t GFR)。根據(jù)雙血漿法測得的GFR結(jié)果,按照美國CKD慢性腎臟病定義對患者進(jìn)行分組:(1)腎功能正常組:GFR≥90 ml/min×1.73m~2;(2)腎功能輕度受損組:60≤GFR90 ml/min×1.73m~2;(3)腎功能中重度受損組:GFR60 ml/min×1.73m~2。所得數(shù)據(jù)用均數(shù)±標(biāo)準(zhǔn)差表示,運(yùn)用配對t檢驗(yàn)、Bland-Altman法、內(nèi)部相關(guān)系數(shù)(ICC)法以及ROC曲線進(jìn)行統(tǒng)計(jì)學(xué)分析,P0.05差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.GFR≥90 ml/min×1.73m~2:g GFR、a GFR分別與雙血漿法(t GFR)相比差別均無統(tǒng)計(jì)學(xué)意義(t g GFR=-0.611,P g GFR=0.56,t a GFR=0.376,P a GFR=0.716),而d GFR、ad GFR均顯著高于t GFR(t d GFR=-5.292,P d GFR=0.001,t ad GFR=-4.979,P ad GFR=0.002);g GFR、d GFR、a GFR、ad GFR均與t GFR有較好的一致性(ICC分別為0.79、0.67、0.91、0.70),其中a GFR與t GFR一致性最好。2.60≤GFR90 ml/min×1.73m~2:g GFR、a GFR分別與雙血漿法(t GFR)相比差別均無統(tǒng)計(jì)學(xué)意義(tg GFR=-0.635,Pg GFR=0.531,t=a GFR=0.993,P a GFR=0.33),d GFR、ad GFR的值均顯著高于t GFR(t d GFR=-6.184,P d GFR0.001,t ad GFR=-6.787,P ad GFR0.001);其中g(shù) GFR、d GFR、a GFR、ad GFR均與t GFR一致性偏低(ICC分別為0.58、0.54、0.78、068)。3.GFR60 ml/min×1.73m~2:只有a GFR與雙血漿法(t GFR)差別無統(tǒng)計(jì)學(xué)意義(ta GFR=-2.091,Pa GFR=0.061),g GFR、d GFR、ad GFR的值均高于t GFR(t g GFR=-3.081,P g GFR=0.01,t d GFR=-6.029,P d GFR0.001,t ad GFR=-5.721,P ad GFR0.001)。四者與t GFR有良好的一致性(ICC分別為0.94、0.89、0.96、0.91)。結(jié)論:1、對于腎功能正�；蜉p度受損的腎積水患者,Gates法和CT面積感興趣區(qū)校正法均與雙血漿法有很好的相關(guān)性,而CT面積感興趣區(qū)校正法較常規(guī)Gates法與雙血漿法所獲GFR具體更好的相關(guān)性。2、對于腎功能中重度受損的腎積水患者,CT面積感興趣區(qū)校正法所獲GFR較其他方法具有更好的準(zhǔn)確性。
[Abstract]:Objective: to evaluate the accuracy of total GFR measured by 99mTc-DTPA dual-plasma GFR method in patients with hydronephrosis by means of depth correction of the area of interest by CT depth correction and correction of the area of interest by using the Gates method of Tc-DTPA renal dynamic imaging in patients with hydronephrosis. Methods: there were 47 patients with hydronephrosis, including 20 males and 27 females, with an average age of 44.53 鹵11.62 years old and 21 59 years old. All of them were diagnosed as hydronephrosis by B-ultrasound, including 35 patients with unilateral hydronephrosis and 12 patients with bilateral hydronephrosis. Using routine diuretic renal dynamic imaging, all the patients were injected with 99mTc-DTPA-185 MBqA via cubital vein "pellet", followed by dynamic sampling of both kidneys for 30 mins, and 40 mg furosemide was injected at the time of 15min. Local CT scan of renal area was performed after collection. According to the procedure taken by the instrument, the two kidney images were processed, and the total kidney GFRG GFRN was obtained according to the Gates method; the GFRD GFRN was measured on the CT image after the depth of the two kidneys was corrected; and the area of interest in the kidney was delineated on the CT image. The maximum area of kidney after superposition was taken as the area of kidney obtained by CT. According to the size and profile of the kidney area as the roi of the two kidneys, the area corrected GFRA GFRN was obtained, and the GFR of the CT kidney area correction and the CT renal depth correction was used as the area depth correction method. At the time of injection of 120min and 240min, the blood samples of 5ml were collected from the contralateral cubital vein, and the serum of 1ml was collected after centrifugation of 10min. The radioactivity count of 1ml was measured, and the value of 5ml was calculated by the formula of double plasma method. According to the results obtained by the double plasma method, the patients were divided into two groups according to the definition of CKD chronic kidney disease in the United States. The patients with normal renal function were divided into two groups: the group with normal renal function 鈮，

本文編號：1996616