应用99mTc-DTPA肾动态显像评价心脏移植术后1个月及1年肾功能的变化

摘要

Objective: To evaluate the renal function changes by "Tc-DTPA renal dynamic imaging in patients at 1 month and 1 year after heart transplantation.rnMethods: A total of 81 patients with heart transplantation were monitored for their renal function by 'Tc-DTPA renal dynamic imaging at 1 month and 1 year after the operation. Renal dysfunction ( RD ) was defined as glomemlar filtration rate( GFR ) <60 ml/min. The patients were divided into RD before transplantation group,n = 25 and Non-RD before transplantation group, n = 56. We compared the renal function in both groups and studied the effect of immunosuppressive drugs cyclosporine and tacroli-mus in all patients.rnResults: The incidences of RD were 30. 9% ,43. 2% and 60. 5% as pre-transplantation,l month and 1 year after transplantation, and severe RD was 6. 2% at 1 year after transplantation. The average CFR was lower at 1 year after the operation than it was before,(56. 72±19. 08 ) vs. ( 70. 81 ±20. 80 ) ml/min,P<0. 01, while the serum creatinine level was similar,P>0. 05. In RD before transplantation group,CFR elevated at 1 month after the operation than it was before,( 56. 08±17. 62 ) vs. ( 47. 71± 9. 98 ) ml/min,P<0. 05. In Non-RD before transplantation group,CFR decreased at 1 month and 1 year after the operation than they were before, ( 68. 80 ± 18. 39 ) and ( 59. 71 ± 19. 17 ) vs. ( 81. 21 ± 15. 27 ) ml/min, P<0. 01. The patients using postoperative cyclosporine had higher incidence of RD at 1 year after the operation than the)' were before as 68. 2% vs. 28. 3% , P<0. 01, while no such difference in patients using post-operative tacrolimus. The rejection over class II was similar for both drugs at 1 year after the operation.rnConclusion: CFR is decreased at 1 year after heart transplantation,serum creatinine remains similar. ""Tc-DTPA renal dy-namic imaging is good for evaluating renal function.%目的:应用99mTc-DTPA肾动态显像评价心脏移植患者术后1个月及1年肾功能的变化.方法:分析81例经99mTc-DTPA肾动态显像评价肾功能的心脏移植患者术后1个月、术后1年肾功能的变化,另定义肾小球滤过率(GFR)<60 ml/min为肾功能不全,将患者分为术前肾功能不全组(n=25)和术前非肾功能不全组(n=56)进行分析.分析术后应用免疫抑制剂环孢素者或他克莫司者术后1个月、术后1年肾功能不全发生率的变化.结果:心脏移植术前、术后1个月及术后1年肾功能不全发生率分别为30.9%、43.2%和60.5%,术后1年严重肾功能不全发生率6.2%.全组患者心脏移植术后1年GFR(56.72±19.08)ml/min较术前GFR(70.81±20.80)ml/min显著降低(P<0.01),差异有统计学意义,而血肌酐术后1年与术前相比无显著差异(P>0.05).术前肾功能不全组,心脏移植术后1个月GFR(56.08±17.62)ml/min与术前GFR(47.71±9.98)ml/min相比显著升高(P<0.05),术后1年GFR(50.02±17.45)ml/min较术前增高,但无显著差异;术前非肾功能不全组,心脏移植术后1个月GFR(68.80±18.39)ml/min、术后1年GFR(59.71±19.17)ml/min较之术前GFR(81.21±15.27)ml/min均显著降低(P<0.01),差异有统计学意义.术后应用免疫抑制剂环孢素者肾功能不全发生率术后1年(68.2%)与术前(28.3%)相比显著升高(P<0.01),而应用他克莫司者无显著差异,且两者术后1年时Ⅱ级以上排异反应的发生率无显著差异.结论:心脏移植术后1年GFR显著降低,但血肌酐升高不明显,应用99mTc-DTPA肾动态显像较之血肌酐评价肾功能有优势.