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目的探讨~(99m)Tc-DTPA肾动态显像测定肾小球滤过率(glomerular filtration rate,GFR)在糖尿病肾脏病变早期诊断中的应用价值。方法根据尿白蛋白排泄率(urinary albumin excretion rate,UAER)将患者分为正常白蛋白尿、微量白蛋白尿和大量白蛋白尿3组。比较不同组别的GFR及同期血生化指标的差异,分析各组GFR下降的发生率并探讨2型糖尿病患者GFR降低的影响因素。结果①2型糖尿病白蛋白尿的发生率为50.47%。与正常白蛋白组比较,微量白蛋白组空腹血糖(fasting blood glucose,FBG)水平明显升高,组间比较差异具有统计学意义(P<0.05),其它血生化指标及GFR差异无统计学意义(P>0.05);大量白蛋白尿组GFR明显降低,FBG和血尿素氮(blood urea nitrogen,BUN)、血肌酐(serum creatinine,SCr)、胆固醇(cholesterol,CH)、低密度脂蛋白(low-density lipoprotein,LDL)明显升高。②3组GFR减低率分别为49.06%、63.64%和75.00%,大量白蛋白尿组GFR减低率明显高于正常白蛋白尿组;正常白蛋白尿组中有24.53%(13/53)的患者GFR<60 ml/min,而GFR<60 ml/min的患者中33.33%(13/39)尿白蛋白水平正常。③与GFR减低相关的影响因素主要有年龄、收缩压(systolic blood pressure,SBP)、UAER等。结论 2型糖尿病患者应在检测尿白蛋白的基础上进一步测定GFR,才能更加全面地评价肾脏受损程度。
Objective To investigate the value of ~ (99m) Tc-DTPA renal dynamic imaging in the early diagnosis of diabetic nephropathy by measuring the glomerular filtration rate (GFR). Methods According to urinary albumin excretion rate (UAER), patients were divided into three groups: normal albuminuria, microalbuminuria and massive albuminuria. The differences of GFR and blood biochemical indexes in different groups were compared. The incidence of GFR decline in each group was analyzed and the influencing factors of GFR reduction in type 2 diabetes mellitus were explored. Results ① The incidence of type 2 diabetes mellitus was 50.47%. The level of fasting blood glucose (FBG) in microalbumin group was significantly higher than that in normal albumin group (P <0.05), while there was no significant difference in other blood biochemical parameters and GFR (P> 0.05). GFR in a large number of albuminuria group was significantly lower than that in control group (P <0.05). FBG and BUN, serum creatinine (SCr), cholesterol (CH), low density lipoprotein -density lipoprotein, LDL) was significantly higher. (2) The GFR reduction rates of the three groups were 49.06%, 63.64% and 75.00%, respectively. The reduction rate of GFR in a large amount of albuminuria group was significantly higher than that of the normal albuminuria group. In normal albuminuria group, 24.53% (13/53) <60 ml / min, whereas 33.33% (13/39) of patients with GFR <60 ml / min had normal urinary albumin levels. (3) The main influencing factors related to the decrease of GFR were age, systolic blood pressure (SBP), UAER and so on. Conclusion Patients with type 2 diabetes should further evaluate GFR on the basis of urinary albumin to evaluate the extent of renal damage more comprehensively.