以腎臟同位素掃描評估早期脊髓傷病人腎絲球過濾率變化之研究

本研究採用腎臟同位素掃描來偵測脊髓損傷病人早期腎功能之變化。自民國77年8月至民國79年3朋共收集35例在本院復健科住院，罹病期間少於6個月的脊髓損傷病人。每一位病人均施以同位素99m Tc-DTPA (Diethylene-Triamine-Penta-Acetic Acid)腎臟掃描。此法可求得左右腎臟之腎絲球過濾率(Glome-rular Filtration Rate, GFR)，有效腎血漿流量(Effective Renal Plasma Flow, ERPF)，及過濾比率(Filtration Fraction, FF)。每一位病人在接受掃描前先測24小時之肌酸酐廓清率(Crea-tinine Clearance Rate, CCR)，並以身高、體重、體表面積等予以校正。將所測得之GFR、ERPF及FF利用最小平方值迴帥直線分析法(Least square fit linear regression analysis)與校正後之CCR分別求其相關性，結果顯示GFR與CCR具最佳之相關性。因此我們利用GFR來評估腎功能變化情形，並依其受捐程度分成四級來分析比較。結果顯示早期脊髓損傷病人GFR降低者約占一半(48.6％)但多為輕度變化。69.2％的胸髓損傷者，55.6％的腰髓損傷者及30.7％的頸髓損傷者GFR有變化。完全損傷者53.9％GFR降低，不完全損傷者則為45.4％。能自行排尿者有42.2％GFR降低，需導尿者則為66.7％。脊髓損傷病人早期之GFR變化多為兩側性(88.2％)，而腎功能正常者有11.1％已開始出現單側腎GFR降低之現象。此外GFR之變化與年齡呈一致性，顯示年齡增加亦為脊髓損傷病人腎功能變化因素之一。

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並列摘要

A Techmetium-99m DPTA computer-assisted renal scan and CCR studies were performed on 35 spinal cord injuried patients who had been hospitalized in the rehabilitation ward of Kaohsiung Medical College Hospital for less than 6 months during the peroid of August 1988 to March 1990. For each patient, the glomerular filtration rate (GFR), the effective renal plasma flow (ERPF), and the filtration fraction (FF) were obtained by a renal scan. CCR was measured by conventional procedure and was correced with body length, body weigth and body surface. Least square fit linear regression analysis revealed the best correlation between GFR and CCR. Based on GFR values the renal function was classified into four grades from normal to severe damage and the change of renal function was analyzed using four correspon ding factors. The results showed that the ratio of GFR impairment in early spinal injury is 48.6% (mostly mild impairment). There are not significant differences between levels of lesion, severity of jnjury or successfulness of bladder training by Fisher's exact test. Renal function deteriorated proportionally with age and most of those patients haveing the worst renal function belonged to an old age group. Thus age is also one of the major factors in renal function impairment. Single kidney function impairment was noted in two patients whose total GFR or CCR were in the normal range, which implied the characteristic of early detection of renal dysfunction by renal scan.

並列關鍵字

spinal cord injury ； 99m Tc-DPTA renal imaging ； glomerular filtration rate

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以腎臟同位素掃描評估早期脊髓傷病人腎絲球過濾率變化之研究

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