摘要
目的探讨在^99mTc—DTPA肾动态显像测定。肾小球滤过率（GFR）过程中是否有影响GFR准确性的因素存在，以确保诊断的准确性。方法对326例患者及1例健康志愿者应用^99mTc—DTPA肾动态显像测定GFR。健康志愿者首次检查在饮水500ml后5min进行；第2次检查按常规在饮水500ml后30min进行。结合肾功能曲线和GFR对检测结果进行分析。结果注射放射性的有效剂量与实测剂量不符导致GFR误差共61例，发生率为18．7％（61／326）。在该类患者中有88．5％（54／61）的病例是由于注射点有放射性药物外渗所致。有8．2％（5／61）的病例因袖口过紧导致放射性药物存留在袖口压迫点的远端并缓慢释放。有3．3％（2／61）病例在测量空针筒时没有采集注射器针帽内漏出的放射性，GFR减低。饮水后短时间内注射放射性药物，导致肾功能曲线峰值减低，排泄段抬高，GFR减低。65例糖尿病患者GFR异常增高，而肾功能曲线形态表现为正常。结论GFR的影响因素较多。综合分析肾功能曲线与GFR值，对于发现误差，确保结果的准确性具有重要意义。再密切结合病史和肾脏影像，可以进一步确保诊断的准确性。
Objective To explore the possible factors influencing the accuracy of glomerular filatration rate （GFR） measurement by ^99mTc-DTPA dynamic renal imaging. Methods Three hundred and twenty six patients and one healthy volunteer underwent ^99mTe-DTPA dynamic renal imaging to measure GFR. The patients received 500 ml fluid at 30 to 60 minutes before the examination. For the volunteer, 500 ml fluid was given at 5 minutes before the first examination and at 30 minutes before the second examination. The GFRs were calculated using Gates method. The final results were analyzed combined with renogram and GFR. Results Errors in GFR measurement due to unmatched doses of radioactive contrast used and detected were indicated in 61 patients （18.7%）, among which, radioactive leakage at the sites of injection was found in 88.5% （54/61） and radioactive retention distally to a tight sleeve was found in 8.2% （5/61）. The radioactivity counts of syringe cover were ignored in 2 patients （3.3%） , leading to lowered GFR readings. Injection of radioactive agent shortly after fluid-drinking was associated with lowered maximal counts of the curves, elevated excretory phase of the renogram, and thus reduced GFR. The GFR increased abnormally in 65 patients with diabetes, but the renograms curves were normal. Conclusions GFR measurement may be affected by a number of factors. Comprehensive analysis of GFR and renograms is important to ensure the accuracy of tests. Adding patient＇ s history and kidney imaging study would further improve the diagnostic accuracy.
出处
《中华生物医学工程杂志》
CAS
2009年第6期490-493,共4页
Chinese Journal of Biomedical Engineering
基金
复旦大学附属中山医院管理资金项目（2008-291）
关键词
肾小球滤过率
99M锝五乙酸盐
肾图术
糖尿病肾病
肾动态显像
Glomerular filtration rate
Technetium Tc 99m pentetate
Renography
Diabetic nephropathies
Dynamic renal imaging
