99Tcm-DTPA法肾小球滤过率在肾癌患者术前肾功能评价中的临床意义

The clinical significance of glomerular filtration rate measured by 99Tcm-diethylentriamine pentaacetic acid renal dynamic imaging in renal cell carcinoma patients before surgery

    摘要
  • 摘要:
    目的 探讨99Tcm-DTPA法肾小球滤过率（GFR）在肾细胞癌（RCC）患者术前肾功能评价中的临床意义。
    方法 99例RCC患者，其中行根治性肾切除术（RN）者89例，行保留肾手术（NSS）者10例。术前行99Tcm-二亚乙基三胺五乙酸（99Tcm-DTPA）显像测定GFR。比较RCC患者和对照组（正常供肾者）的GFR差异以及RN组和NSS组患者的GFR差异，并比较GFR和血肌酐、尿素氮在评价RCC患者术前肾功能异常中的差异。统计学方法采用t检验和χ2检验。
    结果 RCC患者双肾GFR (76.4±20.4)ml/min低于对照组(80.6±17.4)ml/min，但二者差异无统计学意义（t=0.650，P > 0.05）。19例(19.2%)RCC患者术前存在肾功能异常（双肾GFR < 60 ml/min），而血肌酐异常（> 133 μmol/L）者仅4例。RCC患者中，NSS组患侧肾脏GFR与RN组相比，差异无统计学意义(34.1±11.7)ml/min vs.(37.9±11.9)ml/min，t=0.975，P > 0.05，对侧肾脏GFR低于RN组(32.7±10.3)ml/min vs.(39.6± 10.1)ml/min，t=0.044，P < 0.05，NSS组术前肾功能异常者比例明显高于RN组（50.0% vs.15.7%，χ2=6.808，P < 0.01）。
    结论 99Tcm-DTPA法测定的GFR能获得RCC患者术前双肾和分肾功能的准确信息，对RCC患者的治疗决策有重要意义。

     

    Abstract:
    Objective To investigate the clinical significance of glomerular filtration rate(GFR) measured by99Tcm-diethylenetriamine pentaacetic acid(99Tcm-DTPA)renal dynamic imaging in renal cell carcinoma(RCC)patients before surgery.
    Methods There were 99 cases of RCC patients, 89 patients undergoing radical nephrectomy(RN)and 10 patients undergoing nephron-sparing surgery(NSS).99Tcm-DTPA renal dynamic imagingwas performed for determiningGFR before surgery.Make a comparison ofGFR between RCC group and control group(normal kidney donors), RN group and NSS group.Make a comparison between GFR and serum creatinine in determining preoperative renal dysfunction of RCC patients.All of the data were analyzed by t-test and χ2-text.
    Results Compared with contral group, total GFR ofRCC patients was lower, but there was nosignificant difference(76.4±20.4)ml/min vs.(80.6±17.4)ml/min, t=0.650, P > 0.05).Nineteen cases(19.2%)of RCC patients had preoperative renal dysfunction(total GFR < 60 ml/min), but only 4 cases performed abnormal serumcreatinine(> 133 μmol/L).There was no significant difference in GFR ofneoplastic kidneys between RN group and NSS group(34.1±11.7)ml/min vs.(37.9±11.9)ml/min, t=0.975, P > 0.05. GFR of contralateral kidneys was lower in NSS group than RN group(32.7±10.3)ml/min vs.(39.6±10.1) ml/min, t=0.044, P < 0.05.The percentage of preoperative renal dysfunction(total GFR < 60 ml/min)in NSS group was significantly higher than in RN group(50.0% vs.15.7%, χ2=6.808, P < 0.01).
    Conclusion GFR can provide the accurate information ofboth kidneys and single kidney before surgery, and this result possessed animportant significance in choice oftreatments.

     

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