利用CT测定人体单肾肾小球滤过率
Determination of Single-Kidney Glomerular Filtration Rate in Human Subjects by Using CT.
作者信息
Kwon Soon Hyo, Saad Ahmed, Herrmann Sandra M, Textor Stephen C, Lerman Lilach O
机构信息
From the Division of Nephrology and Hypertension, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (S.H.K., A.S., S.M.H., S.C.T., L.O.L.) and Division of Nephrology, Soonchunhyang University Hospital, Seoul, South Korea (S.H.K.).
出版信息
Radiology. 2015 Aug;276(2):490-8. doi: 10.1148/radiol.2015141892. Epub 2015 Apr 6.
PURPOSE
To test the hypothesis that computed tomography (CT)-derived measurements of single-kidney glomerular filtration rate (GFR) obtained in human subjects with 64-section CT agree with those obtained with iothalamate clearance, a rigorous reference standard.
MATERIALS AND METHODS
The institutional review board approved this HIPAA-compliant study, and written informed consent was obtained. Ninety-six patients (age range, 51-73 years; 46 men, 50 women) with essential (n = 56) or renovascular (n = 40) hypertension were prospectively studied in controlled conditions (involving sodium intake and renin-angiotensin blockade). Single-kidney perfusion, volume, and GFR were measured by using multidetector CT time-attenuation curves and were compared with GFR measured by using iothalamate clearance, as assigned to the right and left kidney according to relative volumes. The reproducibility of CT GFR over a 3-month period (n = 21) was assessed in patients with renal artery stenosis who were undergoing stable medical treatment. Statistical analysis included the t test, Wilcoxon signed rank test, linear regression, and Bland-Altman analysis.
RESULTS
CT GFR values were similar to those of iothalamate clearance (mean ± standard deviation, 38.2 mL/min ± 18 vs 41.6 mL/min ± 17; P = .062). Stenotic kidney CT GFR in patients with renal artery stenosis was lower than contralateral kidney GFR or essential hypertension single-kidney GFR (mean, 23.1 mL/min ± 13 vs 36.9 mL/min ± 17 [P = .0008] and 45.2 mL/min ± 16 [P = .019], respectively), as was iothalamate clearance (mean, 26.9 mL/min ± 14 vs 38.5 mL/min ± 15 [P = .0004] and 49.0 mL/min ± 14 [P = .001], respectively). CT GFR correlated well with iothalamate GFR (linear regression, CT GFR = 0.88*iothalamate GFR, r(2) = 0.89, P < .0001), and Bland-Altman analysis was used to confirm the agreement. CT GFR was also moderately reproducible in medically treated patients with renal artery stenosis (concordance coefficient correlation, 0.835) but was unaffected by revascularization (mean, 25.3 mL/min ± 15.2 vs 30.3 mL/min ± 18.5; P = .097).
CONCLUSION
CT assessments of single-kidney GFR are reproducible and agree well with a reference standard. CT can be useful to obtain minimally invasive estimates of bilateral single-kidney function in human subjects.
目的
检验以下假设：在接受64层CT扫描的人体受试者中，通过计算机断层扫描（CT）得出的单肾肾小球滤过率（GFR）测量值与采用碘他拉酸盐清除率这一严格参考标准所获得的测量值一致。
材料与方法
机构审查委员会批准了这项符合《健康保险流通与责任法案》（HIPAA）的研究，并获得了书面知情同意书。对96例患有原发性高血压（n = 56）或肾血管性高血压（n = 40）的患者（年龄范围51 - 73岁；46例男性，50例女性）在可控条件下（包括钠摄入和肾素 - 血管紧张素阻断）进行前瞻性研究。使用多探测器CT时间 - 衰减曲线测量单肾灌注、体积和GFR，并与采用碘他拉酸盐清除率测量的GFR进行比较，根据相对体积将碘他拉酸盐清除率测量值分配至右肾和左肾。在接受稳定药物治疗的肾动脉狭窄患者中评估3个月内CT GFR的可重复性（n = 21）。统计分析包括t检验、Wilcoxon符号秩检验、线性回归和Bland - Altman分析。
结果
CT GFR值与碘他拉酸盐清除率测量值相似（均值±标准差，38.2 mL/min ± 18 对比 41.6 mL/min ± 17；P = 0.062）。肾动脉狭窄患者狭窄侧肾脏的CT GFR低于对侧肾脏GFR或原发性高血压患者的单肾GFR（均值分别为23.1 mL/min ± 13对比36.9 mL/min ± 17 [P = 0.0008] 和45.2 mL/min ± 16 [P = 0.019]），碘他拉酸盐清除率测量结果同样如此（均值分别为26.9 mL/min ± 14对比38.5 mL/min ± 15 [P = 0.0004] 和49.0 mL/min ± 14 [P = 0.001]）。CT GFR与碘他拉酸盐GFR相关性良好（线性回归，CT GFR = 0.88×碘他拉酸盐GFR，r² = 0.89，P < 0.0001），并采用Bland - Altman分析来确认一致性。在接受药物治疗的肾动脉狭窄患者中，CT GFR也具有一定的可重复性（一致性系数相关性，0.835），但不受血运重建的影响（均值，25.3 mL/min ± 15.2对比30.3 mL/min ± 18.5；P = 0.097）。
结论
CT对单肾GFR的评估具有可重复性，且与参考标准高度一致。CT有助于在人体受试者中获得双侧单肾功能的微创性估计值。
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