摘要
目的 探讨^99mTc-DTPA肾动态显像在评价活体肾移植供者肾小球滤过率（GFR）中的应用,并观察GFR水平与供者年龄和性别的相关性.方法 212名候选供者均接受肝肾超声波、肝炎病毒感染以及与受者的血型和组织配型等全面检查,如上述检查符合供肾的一般要求,则进一步行^99mTc-DTPA肾动态显像检测候选供者的GFR,如GFR≥1.33 ml/s（1 ml/s=60 ml/min）,则认为GFR正常;如1.17 ml/s≤GFR＜1.33 ml/s,则行内生肌酐清除率（CCr）检查,如CCr正常,则认为GFR正常,如CCr异常,则候选供者放弃供肾;如GFR＜1.17 ml/s,则候选供者放弃供肾.供者选取后,应用等级相关系数分析不同性别和不同年龄供者间的GFR水平的差异.结果 212名候选供者中,GFR≥1.33 ml/s者137名;1.17 ml/s≤GFR＜1.33 ml/s者55名,其中31名因CCr异常或其他安全性考虑而放弃供肾;GFR＜1.17 ml/s者20名.共有161名候选供者最终被选择为供者供肾,其中男性105名,女性56名,年龄（42.91±11.90）岁（20～62岁）.供肾前,男性和女性供者双肾总的GFR分别为（1.51±0.22）ml/s和（1.45±0.18）ml/s,二者间差异无统计学意义（P＞0.05）;不同年龄各组间GFR水平的差异均无统计学意义（P＞0.05）,老年（＞55岁）和中青年（≤55岁）供者间GFR水平分别为（1.48±0.22）ml/s和（1.49±0.17）ml/s,二者间差异无统计学意义（P＞0.05）.相关性分析显示,供者GFR与其年龄无明显相关性（r=-0.033,P=0.69）,男性和女性供者的GFR水平与其年龄也无明显相关性（r=-0.053,P=0.571;r=-0.019,P=0.754）.供肾后,所有供者短期内肾功能均恢复至正常水平,未发生肾功能异常和严重并发症.结论 ^99mTc-DTPA肾动态显像在评价活体肾移植供者GFR中具有较好准确性和可重复性;1.33 ml/s＞GFR≥1.17 ml/s者经严格筛选后可作为供者供肾,且预后良好;供者GFR水平与其年龄和性别间无明显相关性.
Objective To investigate the clinical application of ^99mTc-DTPA renography in evaluating the glomerular filtration rate （GFR） in living donor kidney transplantation and to assess the dependence of GFR on age and gender in living kidney donors. Methods There were 212 consecutive potential donors in the study. The potential donor evaluation process included as follows： general health status, liver and kidney ultrasound, hepatitis virus infection and HLA-DR matching. If the results met the general requirements for the donor selection criteria, the GFR was measured using the ^99mTc-IDTPA renography according to standard procedure （gates method）. The GFR ≥ 1.33 ml/s was considered normal, 〈 1.17 ml/s was defined as the lower limit for donor GFR, and 1.17 ml/s ≤GFR 〈 1.33 ml/s further underwent measurement of creatinine clearance （CCr）. If the CCr was normal, the GFR was considered normal, and otherwise, potential donors gave up kidney donation.All the donors meeting the donor selection criteria were divided into four age groups. On the other hand, the total donors were divided into the groups aged 〉 55 years and aged ≤ 55 years. The impact of gender and age on GFR was evaluated preoperation due to age-related changes and gender using Kendall＇s tau-b correlation coefficient. Results In 212 potential donors, 137 cases had a GFR ≥ 1.33ml/s, 55 cases 1.17 ml/s ≤ GFR 〈 1.33 ml/s and 20 cases GFR 〈 1.17 ml/s. Thirty-one cases of potential donors with 1.17 ml/s ≤ GFR 〈 1.33 ml/s gave up kidney donation due to abnormal CCr or other security considerations. 161 （56 females, 105 males） were qualified as successful donors, and the donor age was 42. 91 ± 11.90 years （range 20 to 62 years）. The preoperative total GFR （ml/s） in living kidney donors was calculated as 1.51 ± 0.22 for males, it was 1.45 ± 0.18 for females respectively （P〉0.05）. Among the four age groups, there was no significant difference in GFR （P〉0.05）. The GFR in the donors aged 〉 55 years and aged ≤ 55 years was 1.48 ± 0.22 and 1.49 ±0.17 respectively （P〉0.05）. Correlation analysis revealed that the GFR in all the donors was not related with age （r = -0. 033, P = 0. 69）. Also, there was no correlation between age and GFR in men and women（r= -0.053, P=0.571; r= -0.019, P=0.754）. Conclusion ^99mTc-DTPA renography is reliable and reproducible for the determination of GFR in living kidney donors. In view of acute donor shortage and if properly screened, kidneys with 1.17 ml/s≤ GFR 〈 1.33 ml/s can be used without increasing the risk to donor. The GFR is not correlated with the age and gender.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2010年第8期481-484,共4页
Chinese Journal of Organ Transplantation
关键词
肾移植
活体供者
肾小球滤过率
DTPA
Kidney transplantation
Living donors
Glomerular filtration rate
DTPA
