核素肾动态显像联合实验室检查评估含顺铂化疗患者早期肾损害临床价值

时间:2022-05-22 08:17:15

核素肾动态显像联合实验室检查评估含顺铂化疗患者早期肾损害临床价值

【摘要】目的:探讨99mTc-二乙三胺五醋酸(99mTc-DTPA)肾动态显像联合实验室检查评估含顺铂(DDP)化疗患者早期肾功能损害的临床价值。方法:对26例非小细胞肺癌和20例胃癌首次化疗患者在化疗2周期前后分别进行99mTc-DTPA肾动态显像,测定肾小球滤过率(GFR)、高峰时间(Tb)、半排时间(C1/2),患者行肾动态显像当天(间隔不超过24h)检测血清肌酐(Scr)、尿素氮(BUN)、尿微量白蛋白(UMA)、尿β2球蛋白(β2-MG),和胱抑素C(Cys C)水平。结果:双肾血流灌注峰值下降,46例患者总GFR均值化疗后为64.3毫升/分钟,较化疗前86.3毫升/分钟明显下降(P

【关键词】核素显像;肺癌;胃癌;化疗;肾功能

【中图分类号】R737.11;R817.4【文献标识码】A文章编号:1004-7484(2012)-05-0749-02

Clinical Value of Evaluating the early effect of Chemotherapy on renal function Using Radionuclide Renal Dynamic Imaging and Laboratory examination in Patients Treated With DDPMAO Xi-bao,SHENG Gui-feng,SONG Hong-lei,JIANG Ling-yun,BAO Wen-jun,XUE Ning-juan,LING Yang

【Abstract】Objective:To observe the clinical value of renal dynamic imaging and laboratory examination in detecting the early changes of renal function after chemotherapy in patients treated with DDP.Methods:26 patients with non-small cell lung cancer (NSCLC) and 20 patients with gastric cancer were performed 99mTc-DTPA renal dynamic imagings before and after chemotherapy The glomerular filtration rate(GFR),the peaktime(Tb) and the half activity time(C1/2) were gained,and simultaneously,the finding was analyzed along with serum creatinine (Scr) and blood urea nitrogen (BUN),Urine micro-albumin(UMA),β2-microglobin(β2-MG),Cystatin C(Cys C).Results:GFR in 46 patients after chemotherapy was obviously decreased in comparison with that before chemotherapy (P

【Key words】Radionuclide imaging;Lung cancer;Gastric cancer;Chemotherapy;Renal function化疗是恶性肿瘤的主要治疗方法之一,铂类药物是临床上常用的广谱抗癌药,但其应用范围和剂量大小受肾毒性(其中顺铂发生率为28%-36%)的限制[1],顺铂(DDP)主要损害近端肾小管,剂量过大或用药过频,可导致药物在体内蓄积,使肾小管发生不可逆性损伤,甚至可导致非少尿性急性肾功能衰竭。因此,加强患者化疗期间肾功能的监测,尽早发现肾毒性尤为重要,如何切实有效地保证肿瘤患者的化疗质量,减轻肾损伤,更好地发挥顺铂的抗肿瘤作用,已成为一个很重要的研究课题。99mTc-DTPA几乎完全经肾小球滤过而清除,其最大清除率即为GFR,GFR值的大小与肾小球滤过功能成正比,目前临床上判断肾功能的实验室指标主要有血清肌酐(SCr),尿素氮(BUN),尿微量白蛋白(UMA),尿β2-球蛋白(β2-MG),胱抑素C(Cys C)水平等。多年来,临床上将BUN和Scr作为DDP肾毒性的监测指标。只有当肾小球损伤50%-70%时BUN、Scr方有异常,故难以发现早期肾损害,本文通过研究肿瘤患者核素肾动态显像对含顺铂方案化疗前后肾功能早期损害和相关实验室指标变化,评价其对早期肾损害的临床应用价值。1.资料与方法

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