不同肾小球滤过率检测方法在多囊肾肾功能评价中的临床价值

The clinical value of different GFR methods in renal function evaluation of polycystic kidney diseases

    摘要
  • 摘要:
    目的探讨99Tcm-二亚乙基三胺五乙酸（99Tcm-DTPA）肾动态显像Gate's法及血肌酐估测法在多囊肾各时期肾小球滤过率（GFR）检测中的应用价值。
    方法选择2006年1月至2018年9月未行透析治疗的多囊肾患者59例。参考美国慢性肾脏病及透析的临床实践指南，依据慢性肾病（CKD）分期（1~5期），以双血浆法测定GFR为参考标准，将多囊肾患者分为3组。A组：GFR ≥ 60 mL/（min·1.73m2），CKD分期为1~2期，共19例；B组：60 mL/（min·1.73 m2）>GFR ≥ 30 mL/（min·1.73 m2），CKD分期为3期，共23例；C组：GFR < 30 mL/（min·1.73 m2），CKD分期为4~5期，共17例。将Gate's法、血肌酐估测法测定的GFR分别与双血浆法测定的结果进行配对t检验和Pearson相关分析。
    结果（1）血肌酐估测法测得的A、B、C 3组的GFR分别为（85.43±19.77）、（46.56±15.48）、（20.96±11.3）mL/（min·1.73 m2），双血浆法测得的GFR分别为（80.58±16.2）、（42.66±7.63）、（18.61±7.21）mL/（min·1.73 m2），两者间的差异均无统计学意义（t=-1.462、-1.592、-1.791，均P>0.05），且均有很好的相关性（r=0.69、0.68、0.92，均P < 0.05）。（2）Gate's法测得的A、B、C 3组的GFR分别为（75.39±20.75）、（42.86±18.95）、（25.85±14.91）mL/（min·1.73 m2），与双血浆法测定的GFR比较，两者在A、B组中的差异均无统计学意义（t=1.255、-0.061，均P>0.05），且均有很好的相关性（r=0.55、0.62，均P < 0.05）；但是，两者在C组中的差异有统计学意义（t=-2.132，P < 0.05），且无明显相关性（r=0.36，P>0.05）。
    结论Gate's法可很好地评估多囊肾CKD分期为1~3期的患者的肾功能GFR，但对CKD分期为4~5期的患者不适合。血肌酐估测法可有效评价多囊肾CKD各时期的肾功能GFR。

     

    Abstract:
    ObjectivesTo investigate the application value of 99Tcm-diethylene-triaminepentaacetic acid(99Tcm-DTPA) renal dynamic imaging (method A) and blood creatinine estimation method(method B) in glomerular filtration rate (GFR) detection in different stages of polycystic kidney diseases.
    MethodsA total of 59 polycystic kidney patients without dialysis were divided into the following groups by the gold standard method of double plasma (method C):Group A, GFR ≥ 60 mL/(min·1.73 m2) (including chronic kidney disease(CKD)1-2, 19 cases); Group B, 60 mL/(min·1.73 m2) > GFR ≥ 30 mL/(min·1.73 m2) (including CKD 3, 23 cases); Group C, GFR < 30 mL/(min·1.73 m2) (including CKD 4-5, 17 cases). The method A GFR and method B GFR were respectively matched with the method C GFR for t-test and Pearson correlation analysis.
    Results(1) The method B GFR in Group A, B and C were (85.43±19.77), (46.56±15.48), (20.96±11.3) mL/(min·1.73 m2). The method C GFR were (80.58±16.2), (42.66±7.63), (18.61±7.21) mL/(min·1.73 m2) respectively. There was no significant difference between method B and method C in Groups A, B and C(t=-1.462, -1.592, -1.791, all P>0.05). In each group, the method B had a good correlation with method C (r=0.69, 0.68, 0.92, all P < 0.05); (2) The method A GFR in Group A, B and C were (75.39±20.75), (42.86±18.95), (25.85±14.91) mL/(min·1.73 m2). There was no significant difference between method A and method C in Groups A and B(t=1.255, -0.061, both P>0.05); A significant correlation between method A and method C in both groups was observed (r=0.55, 0.62, both P < 0.05); In Group C, no significant difference (t=-2.132, P < 0.05) and correlation (r=0.36, P>0.05) between method A and method C.
    ConclusionsGate's method can evaluate renal function in the early stage of polycystic renal disease(CKD 1-3), but the late stage(CKD 4-5) is unsuitable. The blood creatinine estimation method (using the Cockcroft-Gault equation) can evaluate all stages of the renal function of the polycystic kidney disease.

     

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