CT校正肾脏深度、感兴趣区和深度与感兴趣区对肾积水患者GFR的影响研究

发布时间：2018-06-08 17:32

  本文选题：肾积水 + 肾小球滤过率　； 参考：《山西医科大学》2016年硕士论文

【摘要】：目的:以~(99m)Tc-DTPA双血浆法GFR为参考标准,评价肾积水患者~(99m)Tc-DTPA肾动态显像Gates法、CT深度校正、CT感兴趣区面积校正及深度与感兴趣区面积同时校正四种方法所测总GFR值的准确性。方法:共有47例肾积水患者,男性20例,女性27例,平均年龄44.53±11.62岁(21~59岁),均经B超确诊为肾积水患者,其中单侧肾积水患者35例,双侧肾积水患者12例。采用常规利尿肾动态显像,所有患者均经肘静脉“弹丸式”注射~(99m)Tc-DTPA(185MBq),随后即刻行双肾动态采集30min,于15min时注射速尿40mg。采集结束后行肾区局部CT扫描。按照仪器所带程序处理双肾图像,根据Gates法获得总肾GFR(g GFR);在CT图像上测量双肾深度获得双肾深度校正后GFR(d GFR);再在CT图像上勾画肾脏感兴趣区面积,并将叠加后的最大肾脏面积作为CT所得肾脏面积,并依此肾脏面积大小及轮廓作为双肾ROI,测得面积校正后的GFR(a GFR);将CT肾脏面积校正与CT肾脏深度共同校准所得到的GFR为面积深度校正法GFR(ad GFR)。在注射显像剂后第120min和240min时,于对侧肘静脉各抽取5ml血样,离心10min后分别收集1ml血清,测量其放射性计数,利用双血浆法公式计算GFR值(t GFR)。根据双血浆法测得的GFR结果,按照美国CKD慢性肾脏病定义对患者进行分组:(1)肾功能正常组:GFR≥90 ml/min×1.73m~2;(2)肾功能轻度受损组:60≤GFR90 ml/min×1.73m~2;(3)肾功能中重度受损组:GFR60 ml/min×1.73m~2。所得数据用均数±标准差表示,运用配对t检验、Bland-Altman法、内部相关系数(ICC)法以及ROC曲线进行统计学分析,P0.05差异有统计学意义。结果:1.GFR≥90 ml/min×1.73m~2:g GFR、a GFR分别与双血浆法(t GFR)相比差别均无统计学意义(t g GFR=-0.611,P g GFR=0.56,t a GFR=0.376,P a GFR=0.716),而d GFR、ad GFR均显著高于t GFR(t d GFR=-5.292,P d GFR=0.001,t ad GFR=-4.979,P ad GFR=0.002);g GFR、d GFR、a GFR、ad GFR均与t GFR有较好的一致性(ICC分别为0.79、0.67、0.91、0.70),其中a GFR与t GFR一致性最好。2.60≤GFR90 ml/min×1.73m~2:g GFR、a GFR分别与双血浆法(t GFR)相比差别均无统计学意义(tg GFR=-0.635,Pg GFR=0.531,t=a GFR=0.993,P a GFR=0.33),d GFR、ad GFR的值均显著高于t GFR(t d GFR=-6.184,P d GFR0.001,t ad GFR=-6.787,P ad GFR0.001);其中g GFR、d GFR、a GFR、ad GFR均与t GFR一致性偏低(ICC分别为0.58、0.54、0.78、068)。3.GFR60 ml/min×1.73m~2:只有a GFR与双血浆法(t GFR)差别无统计学意义(ta GFR=-2.091,Pa GFR=0.061),g GFR、d GFR、ad GFR的值均高于t GFR(t g GFR=-3.081,P g GFR=0.01,t d GFR=-6.029,P d GFR0.001,t ad GFR=-5.721,P ad GFR0.001)。四者与t GFR有良好的一致性(ICC分别为0.94、0.89、0.96、0.91)。结论:1、对于肾功能正常或轻度受损的肾积水患者,Gates法和CT面积感兴趣区校正法均与双血浆法有很好的相关性,而CT面积感兴趣区校正法较常规Gates法与双血浆法所获GFR具体更好的相关性。2、对于肾功能中重度受损的肾积水患者,CT面积感兴趣区校正法所获GFR较其他方法具有更好的准确性。
[Abstract]:Objective: to evaluate the accuracy of total GFR measured by 99mTc-DTPA dual-plasma GFR method in patients with hydronephrosis by means of depth correction of the area of interest by CT depth correction and correction of the area of interest by using the Gates method of Tc-DTPA renal dynamic imaging in patients with hydronephrosis. Methods: there were 47 patients with hydronephrosis, including 20 males and 27 females, with an average age of 44.53 卤11.62 years old and 21 59 years old. All of them were diagnosed as hydronephrosis by B-ultrasound, including 35 patients with unilateral hydronephrosis and 12 patients with bilateral hydronephrosis. Using routine diuretic renal dynamic imaging, all the patients were injected with 99mTc-DTPA-185 MBqA via cubital vein "pellet", followed by dynamic sampling of both kidneys for 30 mins, and 40 mg furosemide was injected at the time of 15min. Local CT scan of renal area was performed after collection. According to the procedure taken by the instrument, the two kidney images were processed, and the total kidney GFRG GFRN was obtained according to the Gates method; the GFRD GFRN was measured on the CT image after the depth of the two kidneys was corrected; and the area of interest in the kidney was delineated on the CT image. The maximum area of kidney after superposition was taken as the area of kidney obtained by CT. According to the size and profile of the kidney area as the roi of the two kidneys, the area corrected GFRA GFRN was obtained, and the GFR of the CT kidney area correction and the CT renal depth correction was used as the area depth correction method. At the time of injection of 120min and 240min, the blood samples of 5ml were collected from the contralateral cubital vein, and the serum of 1ml was collected after centrifugation of 10min. The radioactivity count of 1ml was measured, and the value of 5ml was calculated by the formula of double plasma method. According to the results obtained by the double plasma method, the patients were divided into two groups according to the definition of CKD chronic kidney disease in the United States. The patients with normal renal function were divided into two groups: the group with normal renal function 鈮，

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