摘要
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 with renovascular hypertension and ische- mic nephropathy as its main manifestations. Early diagnosis, accurate evaluation of renal function, and appropriate countermeasures, can, to some extent, prevent and even reverse the progression of RAS. Although there are so far various methods to diagnose RAS and assess renal function, very few technology can analyze morphological and func- tional parameters simultaneously, and furthermore the data on its applicability in the RAS subjects are still scare. Objective To investigate the diagnostic and appraisal value of glomerular filtration rate measured by ^99Tc^m-diethylene triamine pentaacetic acid （^99 Tc^m-DTPA） renal dynamic imaging（Tm-GFR） in young patients with RAS. Methods Diagnostic value of the Tm-GFR in unilateral RAS was assessed according to the results of renal digital artery subtraction angiography （DSA）, and the relativity and consistency between Tm-GFR and conventional renal function evaluation methods were compared. Results Totally 105 young patients [45 males and 60 females, with average age of （26. 1±7.2） years] were divided into RAS group （ 70） and control group （ cases without RAS, n= 35） on the ground of renal artery DSA. No statistical difference was found in age, serum creatinine levels, andtotal Tm-GFR between the two groups （P〉0.05）. Compared with the normal reference value [90 mL/（ min . 1.73 mz ） ], total Tm-GFR was significantly lower （ P = 0. 02 ）, whereas the estimated glomerular filtration rate （eGFR） was strikingly higher in RAS individuals （ P〈0.05 ）. The staging of chronic renal insufficiency varied greatly based on various criteria, and poor correlativity and consistency were found between Tm-GFR and conventional renal func- tion assessments. In unilateral RAS group （n= 58）, Tm-GFR in the affected kidney was significantly lower than that in the unaffected kidney （29.4±12.8 vs 57.3±15.0, P〈0.01）. Howerver, in bilateral RAS subjects （n= 12）, Tm-GFR exhibited no statistical difference between both kidneys among this cohort and control participants. As indicated by ROC curve, the areas under curve （ AUC） were 0. 697 and 0. 679 respectively for the difference or the ratio of bilateral renal Tm-GFR, with no statistic significance between the two methods （P=0.34 ）. The corresponding AUC were 0. 729 and 0. 735 respectively （P=0.72） after excluding the bilateral RAS cases. Of note, the best diagnostic value was found when GFR difference between bilateral kidneys was 15.8 mL/（min . 1.73 m2 ）（with 71.7 % sensitivity and 72.7% specificity）, or when the ratio of GFR between two kidneys was 1.45（with 67.9% sensitivity and 68.2%specificity）. Conclusions Split Tm-GFR is more accurate in the diagnosis of unilat- eral RAS in young subjects. The eGFR calculated by MDRD formula has the best consistency with Tm-GFR.
出处
《中华高血压杂志》
CAS
CSCD
北大核心
2012年第12期1144-1151,共8页
Chinese Journal of Hypertension
关键词
肾小球滤过率
肾动脉狭窄
肾功能
诊断
一致性
Glomerular filtration rate
Renal artery stenosis
Renal function
Diagnosis
Consistency
