C-反应蛋白论文：放射性核素肾显像的临床应用研究

C-反应蛋白：放射性核素肾显像的临床应用研究 C-反应蛋白论文:放射性核素肾显像的临床应用研究 【中文摘要】第一部分99Tcm-DMSA肾显像急性肾盂肾炎血清C-反应蛋白水平检测的临床价值:用99Tcm-DMSA肾显像评价急性肾盂肾炎(APN)血清C-反应蛋白(CRP)水平检测的临床价值。:对80例临床首次诊断为泌尿道感染的女性患者分别检测血清CRP水平和行99m锝-二巯基琥珀酸(99Tcm-DMSA)肾静态显像,将CRP水平检测结果和显像结果进行对比研究。结果:急性肾盂肾炎(APN)组血清CRP水平明显高于单纯尿路感染(UTI)组(15.7?9.8 mg/L vs 4.3 ?2.5mg/L),差异有统计学意义(p<0.01)。CRP水平检测结果和肾显像结果吻合度一般(K=0.61,p<0.01)。检测血清CRP水平诊断APN的灵敏度、特异性、准确性、阳性预测值和阴性预测值分别为66.0%、95.7%、80.0%、94.6%和71.4%,且血清CRP水平和肾脏的损伤程度有明显的相关性。结论:血清CRP水平对APN的早期诊断有价值,且其水平可反映肾脏损伤的程度。第二部分肾癌患者肾小球率过滤减低的相关因素:探讨肾癌(RCC)患者肾小球率过滤减低的相关因素。方法:98例肾癌患者,术前行99m锝-二乙三胺五乙酸(99Tcm-DTPA)GFR测定。根据有无肾功能异常(GFR<60 ml/min)分为两组,行单因素分析,与GFR下降有关的因素再进行线性相关分析和多元回归分析。统计学处理采用t检验、χ2检验。结果:GFR下降组年龄高于GFR正常组(t =-3.524,p<0.01),且有高血压病史的RCC患者GFR下降的比例更高(χ2 =3.902,p<0.05)。线性相关分析:GFR与年龄、Cr、UA 呈负相关(P<0.05),与Hb呈正相关(P<0.05)。通过多元回归分析,年龄、Cr、UA进入回归方程(F=15.81,P=0.000),是肾癌患者GFR减低的主要相关因素。结论:RCC患者GFR降低是多因素作用的结果,其中年龄和高血压病史的影响较大。第三部分核素GFR测定评价肾癌患者术前肾功能的临床意义:探讨核素肾小球滤过率(GFR)测定评价肾癌(RCC)患者术前肾功能的临床意义。方法:98例肾癌(RCC)患者,其中根治性肾切除术(RN)88例,保留肾单位手术(NSS)10例。术前行99m锝-二乙三胺五乙酸(99Tcm-DTPA)GFR测定。(1)比较RCC患者和对照组(正常供肾者)的GFR以及RN组和NSS组GFR的差异;(2)比较GFR和血肌酐判断RCC患者术前肾功能异常的差异;(3)比较RCC患者术后3个月健侧肾脏GFR的变化和肾功能的变化。统计学处理采用t检验、χ2检验。结果:RCC患者双肾GFR为(76.7?20.4 ml/min)低于对照组的(80.6?17.4 ml/min),但差异无统计学意义(t = 0.789 ,p>0.05)。18.4%(18例)的RCC患者术前存在肾功能异常,而血肌酐异常(>133μmol/L)仅3例。RCC患者NSS组患侧肾脏GFR与RN组无统计学差异(34.1?11.7ml/min vs 38.1?11.9 ml/min,t = -1.014 , p>0.05),对侧肾脏GFR低于RN组(32.7?10.3ml/min vs 39.7?10.1ml/min,t = -2.067, p<0.05),NSS组术前肾功能异常比例明显高于RN组(50.0% vs 14.8%,χ 2=7.432,p<0.01)。术前健侧肾GFR值正常者,术后3月健侧肾GFR值无显著变化,肾功能也正常。结论:核素肾动态显像GFR测定能获得RCC患者术前双肾和分肾功能的准确信息,对RCC患者的治疗决策有 重要意义,并可预测患者术后肾功能。 【英文摘要】1. Clinical value of serum C- response protein levels in acute pyelonephritis estimated by 99Tcm-DMSA renal scan: To evaluate the diagnostic value of serum C-response protein (CRP) levels in acute pyelonephritis with 99Tcm-DMSA renal scan.Methods: Serum CRP levels and DMSA scintigraphy were measured for 80 women admitted for suspected febrile UTI (first episode). Make a comparative study with CRP levels and imaging results.Results The mean CRP level was significantly higher in acute pyelonephritis than in UTI without renal lesions (15.7 ?9.8mg/L vs 4.3?2.5 mg/L, P=0.000). CRP levels and results of 99Tcm-DMSA renal scan had moderate goodness of fit(K=0.61,P=0.000). For the prediction of acute pyelonephritis, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CRP measurements were 66.0%、95.7%、80.0%、94.6% and 71.4% respectively. And there was a significant correlation between serum CRP levels and the severity of renal lesions.Conclusions: Serum CRP levels may be useful for early diagnosis of acute pyelonephritis and determination of the severity of renal parenchymal involvement.2. To analysis related factors of reduced glomerular filtration rate in renal cell carcinoma patients: To investigate related factors of reduced glomerular filtration rate in renal cell carcinoma (RCC) patients.Methods: There were 98 cases of RCC patients. 99Tcm-DTPA renal dynamic imaging was performed for determining glomerular filtration rate (GFR) before surgery. According to with or without renal dysfunction, 98 cases were divided into two groups to do univariate analysis. Factors associated with GFR were dealt by linear correlation analysis and multiple regression analysis. All data were analyzed by t-test orχ 2-text.Results: The age of GFR reduction group (GFR <60 ml/min) were higher than GFR normal group (t =-3.524,p<0.01),and then RCC patients with hypertension had higher incidence of GFR decline (χ2 =3.902,p<0.05). Linear correlation analysis showed that age,creatinine(Cr)and uric acid (UA)was negative correlation with GFR(P<0.05),hemoglobin(Hb) was positive correlation with GFR(P<0.05). According to multiple regression analysis, age、Cr and UA entered the regression equation (F=15.81,P=0.000),so they were main factors of GFR decline in RCC patients.Conclusions: GFR decline of RCC patients is the result of multiple factors,in which age and hypertension account for most.3. The clinical significance of glomerular filtration rate measured by 99Tcm-diethylentriamine pentaacetic acid renal dynamic imaging in renal cell carcinoma patients before surgery: To investigate the clinical significance of glomerular filtration rate (GFR) measured by 99Tcm-diethylentriamine pentaacetic acid (99Tcm-DTPA) renal dynamic imaging in renal cell carcinoma patients before surgery.Methods: There were 98 cases of RCC patients,88 patients undergoing radical nephrectomy (RN) and 10 patients undergoing nephron-sparing surgery (NSS). 99Tcm-DTPA renal dynamic imaging were performed for determining glomerular filtration rate (GFR) before surgery. Make a comparison of GFR between RCC group and control group (normal kidney donors). Make a comparison of GFR between RN group and NSS group. Make a comparison between GFR and serum creatinine in determining preoperative renal dysfunction of RCC patients. Follow-up was made in some patients three months after surgery. Make a comparison of uninjured kidney’s GFR and renal function before and after surgery. All data were analyzed by t-test orχ 2-text.Results: Compared with contral group, total GFR of RCC patients was lower,but there was no significant difference (76.7?20.4 ml/min vs 80.6?17.4 ml/min, t= 0.789 ,p>0.05). 18.4% of RCC patients had preoperative renal dysfunction(total GFR <60 ml/min),but only 3 cases performed abnormal serum creatinine(>133μmol/L).There was no significant difference in GFR of neoplastic kindeys between NSS group and RN group(34.1?11.7ml/min vs 38.1?11.9 ml/min,t= -1.014,p>0.05).GFR of contralateral kidneys was lower in NSS group than RN group(32.7?10.3ml/min vs 39.7?10.1ml/min,t=-2.067,p<0.05). The percentage of preoperative renal dysfunction(total GFR <60 ml/min) in NSS group was significantly higher than in RN group(50.0% vs 14.8%,χ2=7.432,p<0.01).Patients with normal GFR of uninjured kidney before surgery had no significant change in GFR of uninjured kidney three months after surgery. Also, they had normal renal function.Conclusions: GFR can provide the accurate information of both kidneys and single kidney before surgery. Thus it is important for treatment decisions and may anticipate prognosis after operation. 【关键词】C-反应蛋白 急性肾盂肾炎 肾癌 放射性核素显像 肾 小球率过滤 肾功能 【英文关键词】C- response protein Acute pyelonephritis Renal cell carcinoma Radionuclide imaging Glomerular filtration rate Renal function 【备注】索购全文在线加好友:1.3.9.9.3.8848 同时提供论文写作一对一指导和论文发表委托服务 【目录】放射性核素肾显像的临床应用研究 中文摘要 4-6 Abstract 6-8 前言 11-15 参考文献 13-15 第一部分 ~(99)Tc~m-DMSA 肾显像评价急性肾盂肾炎血清 C-反应蛋白水平检测的临床价值 15-20 资料与方法 15-16 结果 16-17 讨论 17-18 结论 18-19 参考文献 19-20 第二部分 肾癌患者肾小球滤过率减低的相关因素分析 20-27 资料与方法 20-22 结果 22-24 讨论 24-25 结论 25-26 参考文献 26-27 第三部分 核素GFR 测定评价肾癌患者术前肾功能的临床意义 27-36 资料与方法 27 结果 27-29 讨论 29-32 结论 32-33 参考文献 33-36 展望 36-37 综述 37-47 参考文献 43-47 缩略词表 47-48 附录1:肾癌NSS 后随访1 例 48-49 附录2:肾癌 RN 后随访 1 例 49-50 攻读学位期间公开发表的论文 50-51 致谢 51-52