本文選題：腎小球濾過率 + 腎移植��； 參考：《泰山醫(yī)學院》2014年碩士論文

【摘要】：第一部分 CT增強掃描與SPECT測定活體腎移植供體GFR的對照研究 目的 研究螺旋CT多期增強掃描測定活體腎移植供體腎小球濾過率(GFR)的方法及其與SPECT測定GFR的對照研究。 方法 60例成年活體親屬供腎者術(shù)前均行雙腎螺旋CT多期增強掃描，掃描程序包括一期CT平掃和多期增強掃描(動脈期、靜脈期及延遲期CTU掃描)，對比劑為碘普羅胺(100ml:37g I)，對比劑總量90ml，高壓注射器注射速率4.0ml/s，根據(jù)Patlak方程分別計算雙側(cè)腎臟的腎小球濾過率(glomerular filtration rate，GFR)。作為參照，60例腎移植供體同時行SPECT99mTc-DTPA腎動態(tài)顯像測定雙腎GFR，將CT增強掃描測定的GFR與SPECT99mTc-DTPA腎動態(tài)顯像所測定的GFR相對照，，進行直線回歸與相關(guān)分析。 結(jié)果 60例腎移植供體， CT增強掃描測得的左腎GFR和右腎GFR分別為(64.36±5.38)ml/min、(65.72±5.73)ml/min，總腎GFR為(129.48±10.49)ml/min；SPECT99mTc-DTPA腎動態(tài)顯像測得的左腎GFR和右腎GFR分別為(41.74±5.49)ml/min、(43.36±6.31)ml/min，總腎GFR為(85.09±10.73)ml/min。相關(guān)性分析顯示，兩種方法所測得的GFR相關(guān)性良好，左腎GFR相關(guān)系數(shù)r=0.877，P0.01，直線回歸方程為GFR(CT)=28.525+0.859×GFR(SPECT)，n=60；右腎GFR相關(guān)系數(shù)r=0.877，P0.01，直線回歸方程為GFR(CT)=31.209+0.785×GFR(SPECT)，n=60；總腎GFR相關(guān)系數(shù)r=0.867，P0.01，直線回歸方程為GFR(CT)=57.337+0.848×GFR(SPECT)，n=60。 結(jié)論 螺旋CT多期增強掃描能夠較準確地測定活體腎移植供體單腎GFR及總腎GFR，應(yīng)用螺旋CT多期增強掃描可以實現(xiàn)“一站式”完成腎移植供體術(shù)前腎臟功能和解剖結(jié)構(gòu)的評價。 第二部分 CT增強掃描測定活體腎移植供體GFR不同掃描方法的比較 目的 比較不同掃描方法對CT多期增強掃描測定活體腎移植供體GFR的影響。 方法 30例成年活體親屬供腎者術(shù)前均行雙腎螺旋CT多期增強掃描，掃描程序包括CT平掃和多期增強掃描(動脈期、早期靜脈期、晚期靜脈期及延遲期CTU掃描)。每例計算三次GFR,按不同計算方法分為三組： A組利用動脈期及早期靜脈期掃描所得的兩組數(shù)據(jù)計算GFR；B組利用動脈期及晚期靜脈期掃描所得的兩組數(shù)據(jù)計算GFR； C組利用動脈期、早期靜脈期及晚期靜脈期掃描所得的三組數(shù)據(jù)計算GFR。作為參照，30例供體同時行SPECT99mTc-DTPA腎動態(tài)顯像測定雙腎GFR，將CT增強掃描測得三組GFR與SPECT99mTc-DTPA腎動態(tài)顯像所測定的GFR分別進行對照，進行直線回歸與相關(guān)分析。 結(jié)果 C組計算方法測定的GFR值與SPECT測定的GFR值的相關(guān)性最高，相關(guān)系數(shù)(左腎GFR相關(guān)系數(shù)r=0.906，右腎GFR相關(guān)系數(shù)r=0.905，總腎相關(guān)系數(shù)r=0.899)；B組次之，相關(guān)系數(shù)(左腎GFR相關(guān)系數(shù)r=0.890，右腎GFR相關(guān)系數(shù)r=0.891，總腎GFR相關(guān)系數(shù)r=0.889)；A組相關(guān)性最低，相關(guān)系數(shù)(左腎GFR相關(guān)系數(shù)r=0.875，右腎GFR相關(guān)系數(shù)r=0.875，總腎GFR相關(guān)系數(shù)r=0.864)。 結(jié)論 采用晚期靜脈期掃描并且在動脈期和靜脈期之間增加掃描次數(shù)，采集更多的數(shù)據(jù)繪制主動脈TDC，可以提高CT多期增強掃描測定活體腎移植供體GFR的準確性。
[Abstract]:Part one
Comparative study of CT enhanced scanning and SPECT in detecting GFR of living donor renal transplantation
objective
Objective to study the method of spiral CT multi-phase enhanced scanning for measuring glomerular filtration rate (GFR) in living donor renal transplant recipients and to compare with SPECT in detecting GFR.
Method
Double renal spiral CT multiphase enhanced scan was performed in 60 adult living relative donors before operation. The scanning program included CT plain and multiphase enhanced scan (arterial, venous and delayed CTU), contrast agent is 100ml:37g I, 90ml of contrast agent, 4.0ml/s of injection rate of high pressure syringe, and calculated by Patlak equation respectively. The glomerular filtration rate (glomerular filtration rate, GFR) in the lateral kidneys (GFR). As a reference, 60 renal transplantation donors were performed simultaneously with SPECT99mTc-DTPA renal dynamic imaging to determine the double renal GFR. The CT enhanced GFR was compared with GFR measured by the SPECT99mTc-DTPA renal dynamic imaging, and the linear regression and correlation analysis were performed.
Result
In 60 renal transplantation donors, the left kidney GFR and right kidney GFR were measured by CT enhanced scan (64.36 + 5.38) ml/min, (65.72 + 5.73) ml/min and total kidney GFR (129.48 + 10.49) ml/min, SPECT99mTc-DTPA renal dynamic imaging of left kidney GFR and right kidney GFR were (41.74 + 5.49) ml/min, (43.36 + 6.31) ml/min, and the total kidney was (85.09 + 10.73) related The relationship between the two methods showed that the correlation between the two methods was good, the GFR correlation coefficient r=0.877, P0.01, the linear regression equation were GFR (CT) =28.525+0.859 x GFR (SPECT), n=60, and the GFR correlation coefficient of the right kidney. The equation is GFR (CT) =57.337+0.848 x GFR (SPECT), n=60.
conclusion
The multi phase enhanced spiral CT scan can accurately determine the single kidney GFR and the total renal GFR of the donor kidney transplantation donor. The multi-phase spiral CT scan can be used to evaluate the renal function and anatomical structure of the renal transplantation donor.
The second part
Comparison of different scanning methods for CT enhanced GFR in living donor donors
objective
Objective to compare the effects of different scanning methods on the GFR of living donor renal transplantation by CT multi phase enhanced scanning.
Method
Double renal spiral CT multiphase enhanced scan was performed in 30 adult living relative donors before operation, including CT plain and multiphase enhanced scan (arterial, early venous, late venous and delayed CTU). Three GFR were calculated in three groups according to different methods: A group was obtained by arterial and early venous phase scan The two groups of data were calculated by GFR; group B was used to calculate GFR by two groups of data obtained by arterial and late venous phase scanning. Group C used three groups of data obtained by arterial phase, early venous phase and late venous phase to calculate GFR. as reference, and 30 donors simultaneously performed SPECT99mTc-DTPA renal dynamic imaging for the determination of double kidney GFR, and CT enhanced scan was used to measure three of the renal GFR. Group GFR was compared with GFR measured by SPECT99mTc-DTPA renal dynamic imaging. Linear regression and correlation analysis were performed.
Result
The correlation coefficient (GFR correlation coefficient r=0.906, GFR correlation coefficient r=0.905, total renal correlation coefficient r=0.899) was the highest for the GFR values measured in group C, and the correlation coefficient (GFR correlation coefficient of left kidney, right kidney correlation coefficient, total renal correlation coefficient); The lowest correlation coefficient (left renal GFR correlation coefficient r=0.875, right kidney GFR correlation coefficient r=0.875, total renal GFR correlation coefficient r=0.864).
conclusion
Using advanced venous phase scan and increasing the number of scanning times between arterial and venous phase and collecting more data to draw TDC of aorta can improve the accuracy of CT multiphase enhanced scan to determine the donor GFR of living kidney transplantation.
【學位授予單位】：泰山醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R699.2

【參考文獻】

相關(guān)期刊論文 前10條

1 吳小候;;活體供腎研究進展及展望[J];重慶醫(yī)學;2008年14期

2 張青;胡云;蘇紅媛;肖向春;蔣仁蓉;湯小惠;;核素腎動態(tài)顯像在腎移植親屬供腎功能評估中的作用[J];重慶醫(yī)學;2011年08期

3 俞傳琪;蔣更如;;核素~(99m)Tc-DTPA測定GFR與公式估算GFR的相關(guān)性研究[J];放射免疫學雜志;2008年03期

4 葉露;李瓊;李宏;董峰;劉桂彬;王亮;李峰坦;孫浩然;;動態(tài)增強MRI測量豬單側(cè)腎功能不全模型腎小球濾過率[J];磁共振成像;2012年03期

5 劉雪峰;胡亞濤;;應(yīng)用螺旋CT增強檢查測評腎小球濾過功能的初步研究[J];中國臨床醫(yī)學影像雜志;2007年01期

6 武志峰;周翔平;劉榮波;朱捷;;MR擴散加權(quán)成像在腎功能評價中的應(yīng)用[J];中華放射學雜志;2006年05期

7 曾凡軍;劉斌;蔣繼貧;張偉杰;林正斌;陳知水;明長生;朱蘭;陳忠華;;親屬活體腎移植101例分析[J];中華器官移植雜志;2006年05期

8 許晶晶;肖文波;張雷;張敏鳴;;磁共振彌散加權(quán)成像診斷移植腎急性排異的應(yīng)用研究[J];浙江大學學報(醫(yī)學版);2010年02期

9 郭滿濤;董志堅;鞏寧;馬寧強;尹雅芙;雷曉燕;;磁共振技術(shù)在評估腎臟功能中的臨床應(yīng)用進展[J];中華臨床醫(yī)師雜志(電子版);2012年17期

10 徐榮;付愛珍;梅海濤;劉蓉;;SPECT腎動態(tài)顯像在腎移植中的應(yīng)用[J];中國醫(yī)學計算機成像雜志;2013年05期

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