【作者】 陈松华；

【导师】 杜建强；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2007， 硕士

【摘要】 目的：为了发现治疗糖尿病肾病的最佳时机，我们利用核素Gates’法测定90例患者治疗前后的肾小球滤过率，同时观察所选择患者的中医辩证和西医分期的情况。方法：选择我院以往住院病人中糖尿病肾病患者90例确定为内科疾病组，诊断均符合WHO诊断标准确诊为非胰岛素依赖型糖尿病并达到糖尿病肾病的诊断标准，排除肾功能急性恶化因素、水肿、肢体缺如、心功能不全。其中男49例，女41例；年龄36～65岁，平均48.4岁，根据中医辩证分型分为气阴两虚、阴阳两虚、湿瘀内蕴三种症型；根据慢性肾功能不全分期分为5期，病程平均（11.9±4.5）年。对这些患者依据具体情况使用中西医结合的方式进行治疗，对每个患者进行治疗前后Gates’法检查。并于核素检查当天或之前、之后一天其抽取血样检查BUN及SCr，同时检查尿白蛋白排泄率。记录身高、体重。肘静脉“弹丸”式注射^99mTc—DTPA111MBq后即刻行肾动态图像采集120帧，计算双肾GFR，所测数值均用体表面积标准化。在肾功能图像上分别画出双肾及双侧本底ROI，肾脏ROI是在采集后2～3min的肾脏图像上，沿肾皮质外缘勾画出一个闭合的曲线，它包括完整的肾盂；而本底ROI选择在肾脏外下方距肾皮质边缘8个象素处。通过计算机处理可获得肾图，应用Gates’法可计算出GFR值。结果：在90例患者中，糖尿病肾病早期者有33例，中医辩证分型为气阴两虚的有22例，占66.7％，肾动态显像显示早期存在高滤过、高灌注状态，治疗前后的总GFR值分别为（135.7±4.2）、（100.9±2.1），二者存在明显的差异（p＜0.05）；DNIV者有22例，中医辩证分型为阴阳两虚者16例，占72.7％，治疗前后的总GFR值分别为（48.9±2.5）、（46.2±2.6），二者存在明显差异不明显（p=0.053）；DNV者有25例，中医辩证为湿瘀内蕴者20例，占80.0％，治疗前后的总GFR值分别为（23.3±2.4）、（22.2±1.9），二者之间无统计学差异（p＞0.05）。结论：糖尿病患者早期肾功能改变表现为肾小球高滤过状态。肾脏高滤过一般发生在病程5年以内尚无蛋白尿出现的糖尿病患者，病程越短，GFR升高越明显。^99mTc—DTPA测定GFR是观察肾功能比较灵敏的指标，先于SCr、BUN及UAER出现，可评价患者肾功能并预测患者预后的肾功能，与肾功能分期有一定的相关性。^99mTc—DTPA肾动态显像适合于DN的Ⅰ、Ⅱ、Ⅲ期早期发现、早期诊断，尤其是适合于DN的Ⅰ、Ⅱ期。在糖尿病肾病的早期治疗效果较为明显，至尿毒症前期及尿毒症期效果较差。在糖尿病肾病早期中医辩证为气阴两虚型者通过中医辩证治疗后疗效较好，后期湿瘀内蕴者疗效较差。更多还原

【Abstract】 Objective: To evaluate the clinical value of measuing the glomerular filtrtion rate with ⁹⁹Tc—DTPA （Gates method） to obtain GFR.Methods: Select one hundred and four patient of diabebets nephropathy previously and range them examination group. Those patient accord with diagnosticate standard of non insulin dependentdiabetesmellitus of WHO. Wo eliminate some influence diathesis, for example acute badness of nephridium function、oedema、deformity and wangting hesrt function. These researched patient we do include sixty male and fourty-four female, from twenty-one to eighty years, them average age is fourty-six and third years. We dispart these patient four group dissimilitude, the average course of disease is （11.9±4.5） ages. We make use of ⁹⁹Tc—DTPA to chick sixty-four patient of internal medicine range again. We phlebotomize thest patient to examine BUN and SCr at the same time nuclide examination and before and after a day. This work is need to register them avoirdupois and stature before the examination. A 3 mci（111MBq）/0.5 ml dose of 99mTc—DTPA was injected as a bolus in an antecubital vein. Renal scintigraphic images were collected immediately and the images were processed according to standard procedure to obine GFR. We describe nephridium function images background make use of region of interested （ROI）. Draw the outline of nephridium alonge skinniness. The background of ROI is located belowe nephridium.Our research outcome come from GFR and BUN and SCr of in-patient of disparate nephridium function. These compare rates include also GFR of therapy range to take Chinese traditional medicine up and down.Results: The value of GFR obted form Gated method accorded with the renal function, and han negative correlation with BUN and SCr. The GFR of azotimia of renal dynamic imaging、prophase of uremic、uremic is （61.5±27.6）、（50.1±18.3）、（20.7±12.4）. The GFR of taking Chinese traditional medicine up and down is （50.1±2.3）、（92.0±1.2）,the connection of both is（p<0.05）.Conclusion:The patient of forepart diabetes nephropathy exhibition nephridium guomerolos high transir. These things happen in five years of diabetes nephropathy except albuminuria. The more short of course of disease, the more evidence of GFR. GFR is sensitive on observing renal function. It can evaluate the function of ill kidney and estimate residual renal function after excision. Gates method is acceptable fore evaluating the GFR in patients with normal to moderately diminished renal function, bur it is less precise in those with severe renal insufficiency.更多还原