Fuglsang Stefan, Henriksen Ulrik L, Hansen Hanne B, Bendtsen Flemming, Henriksen Jens H
Department of Clinical Physiology and Nuclear Medicine, 239, Center for Functional and Diagnostic Imaging and Research, Copenhagen, Denmark.
Gastro Unit, Medical Division, 439, Hvidovre Hospital and Medical and Health Faculty, University of Copenhagen, Copenhagen, Denmark.
Clin Physiol Funct Imaging. 2017 Nov;37(6):588-595. doi: 10.1111/cpf.12336. Epub 2016 Jan 14.
In patients with fluid retention, the plasma clearance of Cr-EDTA (Cl obtained by multiexponential fit) may overestimate the glomerular filtration rate (GFR). The present study was undertaken to compare a gamma-variate plasma clearance (Cl with the urinary plasma clearance of Cr-EDTA (Cl ) in patients with cirrhosis with and without fluid retention. A total of 81 patients with cirrhosis (22 without fluid retention, 59 with ascites) received a quantitative intravenous injection of Cr-EDTA followed by plasma and quantitative urinary samples for 5 h. Cl was determined from the injected dose relative to the plasma concentration-time area, obtained by a gamma-variate iterative fit. Cl and Cl were determined by standard technique. In patients without fluid retention, Cl , Cl and Cl were closely similar. The difference between Cl and Cl (Cl - Cl = ΔCl) was mean -0·6 ml min 1·73 m . In patients with ascites, ΔCl was significantly higher (11·8 ml min 1·73 m , P<0·0001), but this value was lower than Cl - Cl (17·5 mL min 1·73 m , P<0·01). ΔCl increased with lower values of GFR (P<0·001). In conclusion, in patients with fluid retention and ascites Cl and Cl overestimates GFR substantially, but the overestimation is smaller with Cl . Although Cl may underestimate GFR slightly, patients with ascites should collect urine quantitatively to obtain a reliable measurement of GFR.
在存在液体潴留的患者中，铬标记乙二胺四乙酸（Cr-EDTA）的血浆清除率（通过多指数拟合得到的Cl）可能会高估肾小球滤过率（GFR）。本研究旨在比较肝硬化伴或不伴液体潴留患者中γ变量血浆清除率（Cl）与Cr-EDTA的尿血浆清除率（Cl）。总共81例肝硬化患者（22例无液体潴留，59例有腹水）接受了定量静脉注射Cr-EDTA，随后在5小时内采集血浆和定量尿液样本。通过γ变量迭代拟合从注射剂量相对于血浆浓度-时间曲线下面积确定Cl。通过标准技术测定Cl和Cl。在无液体潴留的患者中，Cl、Cl和Cl非常相似。Cl与Cl之间的差异（Cl - Cl = ΔCl）平均为-0·6 ml·min⁻¹·73 m²。在有腹水的患者中，ΔCl显著更高（11·8 ml·min⁻¹·73 m²，P<0·0001），但该值低于Cl - Cl（17·5 mL·min⁻¹·73 m²，P<0·01）。ΔCl随GFR值降低而增加（P<0·001）。总之，在有液体潴留和腹水的患者中，Cl和Cl会大幅高估GFR，但Cl的高估程度较小。尽管Cl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。
