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肾小球滤过率(glomerular filtration rate,GFR)是指在单位时间内清除血浆中某一物质的能力。GFR对于肾脏疾病的诊断、观察疗效、估计预后具有重要意义。在GFR的测定方法中,内生肌酐清除率(endogenous creatinine clearance rate, CCr)是目前临床较常用的测定GFR的方法,但当血肌酐(serum creatinine,SCr)增高时,部分肌酐从肾小管排泌,CCr往往会过高估计GFR的真实值,且尿液收集费时,难以精确化,只能粗略地代表GFR,供临床参考。一直以来菊粉清除实验被公认为是测定肾脏GFR的金标准,此方法需要恒量灌注,膀胱导尿、重复收集尿液,其操作繁琐,因此临床上难以开展。放射性同位素标记物作为滤过标志物测定GFR与菊粉的清除结果很接近。国内常用99Tcm-DTPA双血浆法测定GFR,但99Tcm-DTPA血浆蛋白结合率较高,半衰期短,只有大约6 h;而要保证测量的准确性,往往需要采集4~6 h,甚至在肾功能不全的时候,需要采集24 h的血液样本[1]。125I-碘酞酸盐在美国等西方国家开展已有相当长的一段时间,其具有操作简便、安全可靠的特点,是一种更为准确测量肝肾移植患者肾脏GFR的方法。
125I-碘酞酸盐临床应用进展
125I-iothalamate clinical applications
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摘要: 125I-碘酞酸盐在美国应用至今已超过半个多世纪。其主要应用于评价肾小球滤过率(GFR), 特别是在肝肾移植患者中肾功能的评价上具有非常重要的作用, 具有方法简单、准确的特点。目前国内大多采用内生肌酐清除率、99Tcm-DTPA肾动态显像或者99Tcm-DTPA双血浆法来测定GFR。但这些方法评估GFR的价值有限。笔者将系统阐述125I-碘酞酸盐的原理、方法、临床应用、辐射安全等, 以期为国内临床应用奠定基础。Abstract: 125I-iothalamate or Glofil-125 has been widely applicated in the US more than half a century. It mainly applies to the evaluation of glomerular filtration rate(GFR), particularly a very important role in liver and kidney transplant patients on monitoring of renal function. This is a simple, accurate method. However, most of the current domestic use of endogenous creatinine clearance rate, 99Tcm-DTPA renal dynamic imaging or 99Tcm-DTPA double plasma method to determine the GFR. However, these methods had a limited value to assessment GFR. This article describes the system 125I-iothalamate principles, methods, clinical applications, radiation safety, etc., in order to lay the foundation for domestic clinical application.
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