不同肾脏深度估算公式在马蹄肾患者肾动态显像中的实用性评价

Practical evaluation of different renal-depth estimation formulas in renal dynamic imaging for patients with horseshoe kidney

    摘要
  • 摘要:
    目的 以CT实测肾脏深度为参考标准，探讨应用不同估算公式计算马蹄肾患者肾脏深度的准确性。
    方法 回顾性分析2015年1月至2020年12月于重庆医科大学附属第一医院行99Tcm-二亚乙基三胺五乙酸肾动态显像检查的55例马蹄肾患者的临床资料，其中男性33例、女性22例，年龄19~80（42.2±16.3）岁。分别选取双肾肾门最远点和最近点与皮肤的垂直距离，取其平均值作为CT实测肾脏深度。记录患者的性别、年龄、身高和体重。分别采用Tonnesen公式、Taylor公式、北京大学第一医院推荐公式计算肾脏深度。并在公式计算的肾脏深度与CT实测肾脏深度之间进行配对样本t检验、Pearson相关性分析和Bland-Altman一致性分析。
    结果 在55例患者中，Tonnesen公式、Taylor公式、北京大学第一医院推荐公式计算的肾脏深度均小于CT实测肾脏深度，且差异均有统计学意义（左肾：t=−14.04~−6.85，均P<0.01；右肾：t=−15.19~−8.47，均P<0.01）。公式计算与CT实测肾脏深度之间存在显著的相关性（r=0.430~0.528，均P<0.001），与Tonnesen公式和Taylor公式相比，北京大学第一医院推荐公式计算的肾脏深度与CT实测肾脏深度之间的相关性更好（左肾：r=0.528、右肾：r=0.484，均P<0.001）。所有公式均低估了肾脏深度，估算误差随着肾脏深度的增加而增加，且差异均有统计学意义95%置信区间：（0.805~1.471）~（2.347~3.061），均P<0.001。Tonnesen公式计算的肾脏深度与CT实测肾脏深度间偏倚最大左肾：（2.38±1.24） cm，右肾：（2.69±1.30） cm。虽然Taylor公式与Tonnesen公式的相关系数较为接近，但Taylor公式的一致性更好左肾：（1.76±1.29） cm，右肾：（1.70±1.32） cm。北京大学第一医院推荐公式计算的肾脏深度与CT实测肾脏深度之间的偏倚较小左肾：（1.14±1.22） cm、右肾：（1.46±1.27） cm。
    结论 采用Tonnesen公式、Taylor公式、北京大学第一医院推荐公式计算的马蹄肾患者肾脏深度的准确性均不如CT实测，准确评估马蹄肾患者肾小球滤过率建议采用CT实测的肾脏深度。

     

    Abstract:
    Objective To validate the accuracy of different estimation formulas for measuring renal depth in patients with horseshoe kidney using CT actual measured renal-depth as a reference standard.
    Methods The clinical data of 55 patients with horseshoe kidney who underwent 99Tcm-diethylene-triaminepentaacetic acid renal dynamic imaging in the First Affiliated Hospital of Chongqing Medical University from January 2015 to December 2020 were analyzed retrospectively. These patients included 33 males and 22 females aged 19–80 (42.2±16.3) years. The vertical distance between the farthest and nearest points of the renal hilum and the skin of both kidneys were selected respectively, and the average value was taken as the renal-depth. The gender, age, height, and weight of the patients were recorded. The estimated renal-depths were obtained using the Tonnesen, Taylor, and Li Qian formulas, respectively. Paired t test, Pearson correlation analysis, and Bland-Altman analysis were performed between the estimated and CT measured renal-depths.
    Results In 55 patients, the renal-depths calculated by the Tonnesen, Taylor, and Li Qian formulas were all lower than the CT measured renal-depths, and the differences were all statistically significant (left kidney: t=−14.04 to −6.85, all P<0.01; right kidney: t=−15.19 to −8.47, all P<0.01). A significant correlation existed between formulas estimated and CT measured renal-depths (r=0.430−0.528, all P<0.001), but the Li Qian formula correlated better than the Tonnesen and Taylor formula, where the correlation coefficient was (r=0.528, P<0.001) for the left kidney and (r=0.484, P<0.001) for the right kidney. All formulas underestimated the renal-depth; the estimated error increased with increased renal-depth, and the difference was statistically significant (95%CI: (0.805–1.471) to (2.347–3.061), all P<0.001). The bias between the renal-depths estimated by the Tonnesen formula and those measured by CT was the largest (left kidney: (2.38±1.24) cm; right kidney: (2.69±1.30) cm). Although the correlation coefficients of the Taylor and Tonnesen formulas were closer, the Taylor formula had better agreement, with biases of (1.76±1.29) cm and (1.70±1.32) cm for the left and right kidneys, respectively. The bias between the renal-depths derived from the Li Qian formula and those measured by CT was smaller (left kidney: (1.14±1.22) cm; right kidney: (1.46±1.27) cm).
    Conclusions The accuracy of renal-depth in patients with horseshoe kidney calculated using Tonnesen, Taylor, and Li Qian formulas were not as good as the actual CT measurement. Therefore, to accurately assess glomerular filtration rate, CT is recommended to measure the renal-depth of patients with horseshoe kidney.

     

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