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背景肾动脉狭窄(RAS)是一种常见疾病,常表现为肾血管性高血压和缺血性肾病。早期诊断与正确评估患者肾功能并采取相应治疗,可在一定程度上逆转和阻止疾病进展。目前虽然有多种诊断肾动脉狭窄的手段,但很少能兼顾形态学和功能学;虽然现存多种评价肾功能的方法,但缺乏在肾动脉狭窄人群中的适用性研究。目的分析99Tcm-二乙三胺五乙酸(99Tcm-DTPA)肾动态显像测定的肾小球滤过率(Tm-GFR)在年轻RAS患者中的诊断及评估价值。方法根据肾动脉造影(DSA)结果评价Tm-GFR对单侧RAS的诊断价值,同时研究常用肾功能评价方法与Tm-GFR在RAS患者中的相关性和一致性。结果根据肾动脉DSA检查结果将105例(男性45例,女性60例)年轻患者[年龄(26.1±7.2)岁]分为两组:RAS组和非RAS组(对照组)。RAS组(70例)与对照组(35例)的年龄、血肌酐水平和Tm-GFR差异均无统计学意义(P>0.05)。在RAS组,患者的总Tm-GFR与正常参考值[90mL/(min·1.73m2)]相比明显降低(P=0.02),但估算肾小球滤过率(eGFR)与正常值相比明显升高(P<0.05)。以各指标为依据的慢性肾功能不全分期差别很大,各种eGFR算法与Tm-GFR的相关性和一致性较差。在单侧狭窄组(58例),患肾Tm-GFR(29.4±12.8)mL/min较健侧(57.3±15.0)mL/min)明显降低(P<0.01),而在双侧狭窄组(12例)及对照组两侧肾脏的Tm-GFR差异无统计学意义。进一步以双侧Tm-GFR的差值和比值绘制受试者工作特征曲线,曲线下面积(AUC)分别为0.697和0.679,两种方法相比差异无统计学意义(P=0.34)。剔除双侧狭窄组后AUC分别为0.729,0.735,差异无统计学意义(P=0.72)。当双肾GFR的差值为15.8mL/(min·1.73m2)]时其诊断价值最高(灵敏度71.7%,特异度72.7%),双肾GFR比值为1.45时其诊断价值最大(灵敏度67.9%,特异度68.2%)。结论分侧Tm-GFR对于诊断年轻患者单侧RAS价值较高,MDRD公式计算的eGFR与Tm-GFR的一致性最好。
Background Renal artery stenosis (RAS) is a common disease often characterized by renovascular hypertension and ischemic nephropathy. Early diagnosis and correct assessment of patients with renal function and take appropriate treatment, to a certain extent, reverse and prevent disease progression. Although there are several means of diagnosing renal artery stenosis, few are available for morphological and functional studies; although there are many available methods for evaluating renal function, there is a lack of applicability in renal artery stenosis. Objective To analyze the diagnostic value of 99m Tc-DTPA renal dynamic imaging for the determination of glomerular filtration rate (Tm-GFR) in young patients with RAS. Methods The diagnostic value of Tm-GFR on unilateral RAS was evaluated according to the result of renal artery angiography (DSA). The correlation and consistency between common renal function test and Tm-GFR in RAS were also studied. Results According to DSA results of renal artery, 105 cases (45 males and 60 females) of young patients [age (26.1 ± 7.2) years] were divided into two groups: RAS group and non-RAS group (control group). There was no significant difference in age, serum creatinine and Tm-GFR between RAS group (70 cases) and control group (35 cases) (P> 0.05). In the RAS group, the patient’s total Tm-GFR was significantly lower (P = 0.02) compared with the normal reference value of [90 mL / (min · 1.73 m 2)] but the estimated glomerular filtration rate (eGFR) Was significantly higher (P <0.05). The indexes of chronic renal insufficiency based on the staging vary greatly, various eGFR algorithm and Tm-GFR correlation and consistency is poor. In the unilateral stenosis group (58 cases), the Tm-GFR in the kidney (29.4 ± 12.8 mL / min vs 57.3 ± 15.0 mL / min) was significantly lower than that in the unilateral stenosis group (P <0.01) 12 cases) and control group on both sides of the kidney Tm-GFR difference was not statistically significant. The working curve of the subjects was further plotted by the difference between the two Tm-GFR ratios. The area under the curve (AUC) was 0.697 and 0.679, respectively. There was no significant difference between the two methods (P = 0.34). After removing the bilateral stenosis group, the AUC were 0.729 and 0.735, respectively, with no significant difference (P = 0.72). The highest diagnostic value (71.7% sensitivity and 72.7% specificity) was obtained when the difference of GFR between two kidneys was 15.8mL / (min · 1.73m2)]. The diagnostic value of GFR was 1.45 (67.9% Specificity of 68.2%). Conclusion The classification of Tm-GFR is of great value in the diagnosis of unilateral RAS in young patients. The consistency of TGF-GFR and eGFR calculated by MDRD formula is the best.