论文部分内容阅读
目的 了解不同阶段 2型糖尿病 (DM)患者肾脏血流动力学的变化及肾功能受损情况。方法 将 5 7例 2型DM患者根据尿白蛋白排泄率 (UAER)分为三组 :(1)DM正常白蛋白尿组 (DM1组 ) 11例 ,UAER <2 0 μg/min。 (2 )DM微量白蛋白尿组 (DM 2组 ) 2 6例 ,UAER :2 0～ 2 0 0 μg/min。(3)DM临床蛋白尿组 (DM 3组 ) 2 0例 ,UAER >2 0 0 μg/min。与 2 0例正常对照组 (NC)一起进行99mTc 二乙三胺五乙酸 (99mTc DTPA)和99mTc 双半胱氨酸 (99mTc EC)肾动态显像。结果 DM 1组肾小球滤过率 (GFR)及肾有效血浆流量 (ERPF)明显高于NC组 (P <0 .0 1)。DM2组GFR、ERPF与NC组相比无差异 ,但其99mTc DTPA法测定的肾功能曲线半排时间 (T1/2 )延长 (P <0 .0 5 ) ,2 0分钟残留率 (C2 0 )增高 (P <0 .0 5 )。DM 3组GFR、ERPF明显下降 (P <0 .0 1) ,肾功能曲线峰时 (Tp)后延 (P<0 .0 1) ,T1/2 更加延长 (P <0 .0 1) ,C2 0 更加增高 (P <0 .0 1)。结论 核素肾动态显像可早期诊断 2型DM ,并了解肾功能受损程度 ,DN的进程以及为临床治疗和随访提供了依据。
Objective To investigate the changes of renal hemodynamics and renal dysfunction in patients with type 2 diabetes mellitus (DM) at different stages. Methods Fifty-seven patients with type 2 DM were divided into three groups based on the urinary albumin excretion rate (UAER): (1) 11 patients with DM normal albuminuria (DM1 group) and UAER <20 μg / min. (2) DM microalbuminuria group (DM 2 group) 26 cases, UAER: 20 ~ 200 μg / min. (3) DM clinical proteinuria group (DM 3 group) 20 cases, UAER> 200 μg / min. Renal dynamic imaging of 99mTc diethylenetriaminepentaacetic acid (99mTc DTPA) and 99mTc bis-cysteine (99mTc EC) was performed with 20 normal control groups (NCs). Results The glomerular filtration rate (GFR) and renal effective plasma flow (ERPF) of DM group 1 were significantly higher than that of NC group (P <0.01). The GFR and ERPF in DM2 group were not significantly different from those in NC group. However, the renal function curve measured by 99mTc DTPA showed a longer half-life (T1 / 2) (P <0.05) and a 20-minute residual rate Increased (P <0.05). GFR and ERPF in DM 3 group were significantly lower than those in DM 3 group (P <0.01), peak Tp (P <0.01) and T1 / 2 in renal function curve (P <0.01) C2 0 increased further (P <0 .01). Conclusion The radionuclide dynamic imaging can diagnose type 2 DM early, and understand the extent of renal dysfunction, the course of DN, and provide the basis for clinical treatment and follow-up.