99Tcm-DTPA肾动态显像对肝移植术前肾功能的评估及术后早期急性肾损伤的预测价值

摘要

Objective To investigate the value of 99Tcm-diethylene triamine pentoacetic acid (DTPA) renal dynamic imaging for detecting renal function before liver transplantation and predicting early acute kidney injury (AKI) postoperation.Methods A total of 40 patients (29 males,11 females,average age (45± 8) years) with end-stage liver diseases who underwent orthotopic liver transplantation from June 2015 to June 2016 were selected in this retrospective study.All patients underwent 99Tcm-DTPA renal dynamic imaging within one week before liver transplantation,the general glomerular filtration rate (GFR) and normalized GFR (NGFR) were calculated.The serum creatinine (SCr) and blood urea were detected during the perioperative period.Patients were divided into AKI group (n =15) and non-AKI group (n =25) according to whether the patients suffered from AKI 3 d after liver transplantation.The general GFR,NGFR,SCr and blood urea between two groups were compared using two-sample t test.The sensitivities and specificities of general GFR and NGFR for predicting AKI were evaluated by receiver operating characteristic (ROC) curve.Correlations between general GFR,NGFR and SCr,blood area before liver transplantation were investigated by Pearson correlation analysis.Results The general GFR,NGFR before operation in AKI group were significantly lower than those in non-AKI group:(58.6±7.7) ml/min vs (77.3±12.3) ml/min,(57.7±7.5) ml· min-1· 1.73 m-2 vs (76.8±12.6) ml · min-1 · 1.73 m-2(t values:-5.924,-5.981,both P＜0.05).The SCr,blood urea before operation in the 2 group were not significantly different:(93.5±13.0) μmol/L vs (85.8±15.7) μmol/L,(8.9±4.0) mmol/L vs (7.0±3.0) mmoL/L (t values:1.604,1.733,both P＞0.05).The area under curve (AUC) of general GFR and NGFR was 0.947 and 0.944,respectively.The early AKI was predicted by general GFR and NGFR under the cut-off＜60 ml/min and ＜60 ml · min-1 · 1.73 m-2 with sensitivities of 9/15,10/15 and specificities both of 96.0％ (24/25).There were negative correlations between the general GFR and SCr,general GFR and blood urea,NGFR and SCr,NGFR and blood urea (r values:-0.555,-0.391,-0.562,-0.390,all P＜0.05).Conclusions 99Tcm-DTPA renal dynamic imaging is helpful for the early detection of potential injury of the renal function.Both general GFR and NGFR could be the accurate indicators for predicting early AKI following orthotopic liver transplantation.%目的 探讨99Tcm-二乙撑三胺五乙酸(DTPA)肾动态显像对肝移植术前肾功能的评估及术后早期急性肾损伤(AKI)的预测价值.方法 回顾性研究2015年6月至2016年6月间接受原位肝移植术的40例终末期肝病患者,其中男29例,女11例,平均年龄(45±8)岁.患者移植术前1周内均进行了肾动态显像,围手术期检测血清肌酐(SCr)、血尿素.根据术后3d有否发生AKI,将患者分为AKI组(15例)和非AKI组(25例).对2组患者总肾小球滤过率(GFR)、标准化GFR(NGFR)以及SCr、血尿素进行两样本t检验分析,绘制受试者工作特征曲线比较总GFR、NGFR预测术后早期AKI的灵敏度和特异性;并对术前总GFR、NGFR与术前SCr、血尿素的关系行Pearson相关分析.结果 AKI组肝移植术前总GFR、NGFR分别为(58.6±7.7) ml/min、(57.7±7.5) ml·min-1· 1.73 m-2,均明显低于非AKI组的(77.3±12.3) ml/min、(76.8±12.6) ml·min-1· 1.73 m-2,差异有统计学意义(t值:-5.924、-5.981,均P＜0.05).AKI组术前SCr、血尿素分别为(93.5±13.0) μmol/L、(8.9±4.0)mmol/L,非AKI组分别为(85.8±15.7) μmol/L、(7.0±3.0) mmol/L,两组相比差异均无统计学意义(t值:1.604、1.733,均P＞0.05).总GFR、NGFR曲线下面积分别为0.947、0.944,以总GFR＜60 ml/min、NGFR＜60 ml·min-1· 1.73 m-2为分界值预测术后早期AKI的灵敏度分别为9/15、10/15,特异性均为96.0％ (24/25).肝移植术前总GFR与SCr、血尿素,NGFR与SCr、血尿素均呈负相关(r值:-0.555、-0.391、-0.562、-0.390,均P＜0.05).结论 99Tcm-DTPA肾动态显像能早期发现肝移植患者术前肾功能的潜在损害,总GFR与NGFR可作为预测术后早期AKI的可靠指标.