Henriksen Ulrik L, Hansen Hanne B, Ring-Larsen Helmer, Bendtsen Flemming, Henriksen Jens H
Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Hvidovre Hospital , Hvidovre , Denmark.
Scand J Clin Lab Invest. 2015 Jan;75(1):64-72. doi: 10.3109/00365513.2014.980313. Epub 2014 Nov 20.
In patients with fluid retention, the total plasma clearance of (51)Cr-EDTA (ClP) may overestimate the glomerular filtration rate (GFR). The present study was therefore undertaken in order to compare ClP with the urinary plasma clearance of (51)Cr-EDTA (ClU) in patients with cirrhosis with and without fluid retention.
A total of 136 patients with cirrhosis (24 without fluid retention, 112 with ascites) received a quantitative intravenous injection of (51)Cr-EDTA followed by plasma and quantitative urinary samples for 5 hours. ClP was determined from the injected dose relative to the plasma concentration-time area, extrapolated to infinity. ClU was determined as urinary excretion relative to the plasma concentration-time area up to voiding.
In patients without fluid retention, the difference between ClP and ClU (ClP - ClU = ClΔ) was mean 4.5 mL/min/1.73 m(2). In patients with ascites, ClΔ was significantly higher (17.6 mL/min/1.73 m(2), p < 0.0001). ClΔ increased with lower values of GFR (r = - 0.458, p < 0.001). Repeated measurements of ClU in a subgroup of patients with fluid retention (n = 25) gave almost identical values. Different types of corrections of one-pool clearance were almost identical with ClP, except for higher clearance values, which were somewhat underestimated by the former.
In patients with fluid retention and ascites ClP and corrected one-pool clearance overestimates GFR substantially. Although ClU may underestimate GFR slightly, patients with ascites should collect urine quantitatively in order to obtain a reliable measurement of GFR.
在存在液体潴留的患者中，（51）铬 - 乙二胺四乙酸（ClP）的血浆总清除率可能会高估肾小球滤过率（GFR）。因此，本研究旨在比较有或无液体潴留的肝硬化患者中ClP与（51）铬 - 乙二胺四乙酸的尿血浆清除率（ClU）。
总共136例肝硬化患者（24例无液体潴留，112例有腹水）接受了（51）铬 - 乙二胺四乙酸的定量静脉注射，随后在5小时内采集血浆和定量尿液样本。ClP通过相对于血浆浓度 - 时间曲线下面积（外推至无穷大）的注射剂量来确定。ClU通过相对于排尿前血浆浓度 - 时间曲线下面积的尿排泄量来确定。
在无液体潴留的患者中，ClP与ClU之间的差异（ClP - ClU = ClΔ）平均为4.5 mL/min/1.73 m²。在有腹水的患者中，ClΔ显著更高（17.6 mL/min/1.73 m²，p < 0.0001）。ClΔ随着GFR值降低而增加（r = - 0.458，p < 0.001）。对一组有液体潴留的患者（n = 25）重复测量ClU得到几乎相同的值。除了较高的清除率值被前者略微低估外，单池清除率的不同校正类型与ClP几乎相同。
在有液体潴留和腹水的患者中，ClP和校正后的单池清除率显著高估GFR。尽管ClU可能会略微低估GFR，但有腹水的患者应定量收集尿液以获得可靠的GFR测量值。
