Wang J Y, Lu Y S, Wang S J, Cheng C H, Shu K H, Lian J D
Division of Nephrology, Puli Veterans Hospital, Nantou, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1995 Jun;55(6):432-7.
The measurement of 24-hour creatinine clearance (CCr) is most commonly used to estimate glomerular filtration rate (GFR). A new rapid method for determining GFR by radionuclide compound Tc-99m diethylenetriamine-pentaacetic acid (DTPA) has been developed and widely used in the last decade. The purpose of this study is to compare and correlate the measurements of GFR by the two method.
The present series included 6 normal volunteer outpatients and 49 hospitalized patients with various degrees of renal dysfunction who were studied at Taichung Veterans General Hospital from June 1985 to June 1986. All patients underwent both Tc-99m DTPA GFR and 24-hour CCr. Tc-99m DTPA computed GFR was calculated using the formula of Gates.
The radionuclide computed GFR for each subject was compared with his or her 24-hour CCr. The correlation coefficient (r) was 0.89 with p < 0.001. The subjects were divided into two groups. Group A consisted of 6 normal volunteers and 14 patients with serum creatinine less than 1.4 mg/dl (creatinine: normal range 0.7 to 1.4 mg/dl). Group B consisted of 35 patients with serum creatinine greater than 1.4 mg/dl. Group B was further divided into Subgroup 1 with serum creatainine from 1.4 to 10 mg/dl, and Subgroup 2 with serum creatinine above 10 mg/dl. There was good correlation and less absolute error between DTPA-GFR and CCr in Group A and Subgroup 1. The results suggest that, when serum creatinine is less than 10 mg/dl, either DTPA or CCr is a good method for detection of GFR.
DTPA-GFR measurement using this radionuclide technique has shown good correlation with CCr when serum creatinine is under 10 mg/dl. In patients with renal impairment and with serum creatinine above 10 mg/dl, neither examination is reliable. A more sensitive test to evaluate GFR in severe renal impairment is required for further investigation.
24小时肌酐清除率（CCr）测定是最常用于估算肾小球滤过率（GFR）的方法。一种通过放射性核素化合物锝-99m二乙三胺五乙酸（DTPA）测定GFR的新的快速方法已被开发出来，并在过去十年中广泛应用。本研究的目的是比较这两种方法测定GFR的结果并进行相关性分析。
本研究系列包括6名正常门诊志愿者和49名患有不同程度肾功能不全的住院患者，这些患者于1985年6月至1986年6月在台中荣民总医院接受研究。所有患者均接受了锝-99m DTPA GFR和24小时CCr测定。锝-99m DTPA计算的GFR使用盖茨公式计算。
将每个受试者的放射性核素计算的GFR与其24小时CCr进行比较。相关系数（r）为0.89，p<0.001。受试者分为两组。A组由6名正常志愿者和14名血清肌酐低于1.4mg/dl的患者组成（肌酐：正常范围0.7至1.4mg/dl）。B组由35名血清肌酐高于1.4mg/dl的患者组成。B组进一步分为血清肌酐为1.4至10mg/dl的亚组1和血清肌酐高于10mg/dl的亚组2。A组和亚组1中DTPA-GFR和CCr之间存在良好的相关性且绝对误差较小。结果表明，当血清肌酐低于10mg/dl时，DTPA或CCr都是检测GFR的良好方法。
当血清肌酐低于10mg/dl时，使用这种放射性核素技术测定的DTPA-GFR与CCr显示出良好的相关性。对于肾功能损害且血清肌酐高于10mg/dl的患者，两种检查均不可靠。需要进一步研究一种更敏感的试验来评估严重肾功能损害中的GFR。
