Transcript Gates 방법과 혈청 크레아티닌을 이용한 사구체 여과율 비교

Comparison of Glomerular Filtration Rates
using Gates method and Serum creatinine
Jong-Jun Yun
Department of nuclear medicine, Pusan University Hospital
Contents
1
4
Purpose
2
Materials and Method
3
Results
Conclusion
Purpose
신장기능 평가
신장질환 진단
GFR
만성적인 신장질환
질병의 경과관찰
* GFR : Glomerulaur Filtration Rates
Purpose
외부표지자
내부표지자
Inulin
Iohexol
51Cr-EDTA
99mTc-DTPA
125I-iothalamate
Creatinine
BUN
β2-microglobulin
Cystatin C
* BUN : Blood Urea Nitrogen
Purpose
99mTc-DTPA(Gates)
Creatinine
감마카메라를 이용하여 신장 스캔
Cockcroft-Gault (C-G)
사구체 여과율을 측정할 수 있는
비혈관적 방법
Modification of Diet in Renal
Disease(MDRD)
Materials and Method
18세 이상 217명(남자 127명,여자 90명)
연구
평균 연령 51.3±16.9세
대상
신체계측(Hight, Weight 등)
혈청 생화학적검사(BUN, Creatinine 등)
검사
항목
Materials and Method
99mTc-DTPA
5mCi
Gamma Camera(ADAC)
64 matrix, word 방식
방사능 양 측정
배후 방사능 보정
99mTc-DTPA
Analysis
Gates
신장 깊이에 따른
연부조직의 감쇠보정
% Renal Uptake
Materials and Method
Tonnesen 회귀방정식
우측 신장 깊이(㎝)=13.3×{체중(kg)/신장(cm)}+0.7
좌측 신장 깊이(㎝)=13.2×{체중(kg)/신장(cm)}+0.7
GFR(㎖/min)=(% renal uptake)×9.8127-6.82519
* 9.8127 : regression coefficient
* -6.82519 : y-intercept
Materials and Method
혈청 크레아티닌 측정
채 혈
Jaffe
반응
자 동
분석기
Alkaline Picrate 방법
Modular DP(Roche)
Materials and Method
C-G 공식
[(140-연령)×체중(kg)/(72×혈청 크레아티닌)]
(㎖/min/1.73㎡) ×(0.85 여성인 경우)
BSA
체중(kg)×0.425×신장(cm)×0.725×0.007184
(Dubois 공식)
MDRD 공식
186×(혈청 크레아티닌)-1.154×(연령)-0.203
(㎖/min/1.73㎡) ×(0.742 여성인 경우)
* BSA : Body Surface Area
Materials and Method
Mean±SD
SPSS Ver 12.0 Program
Pearson correlation, paired t-test
통계적 유의성 p<0.05
Results
Baseline Charateristics of Subjects
Total
(n=217)
Male
(n=127)
Female
(n=90)
Age(years)
51.3±16.9
50.0±16.8
53.1±16.9
Weight(kg)
63.0±12.0
66.6±11.3
57.8±11.1
Hight(cm)
165.2±8.5
170.5±6.1
157.8±5.1
BSA(㎡)
1.69±0.18
1.77±0.2
1.57±0.1
BMI(kg/㎡)
23.0±3.8
22.9±3.4
23.2±4.2
BUN(㎎/㎗)
33.9±25.8
34.7±25.8
32.7±25.9
Scr(㎎/㎗)
3.0±3.1
3.3±3.3
2.6±2.8
* Scr : Serum Creatinine
Results
Comparison of Glomerular Filtration Rates
Measured by Different Methods
Mean±SD
Pearson
Correlation
99mTc-DTPA
C-G equation
MDRD equation
(㎖/min)
(㎖/min/1.73㎡)
(㎖/min/1.73㎡)
49.9±35.8
57.0±48.9
55.7±46.1
r=0.864
(p<0.0001)
r=0.841
(p<0.0001)
Results
Relationship between 99mTc-DTPA and C-G equation
99mTc-DTPA(
r=0.864
(p<0.0001)
/min)
㎖
C-G (㎖/min/1.73㎡)
Results
Relationship between 99mTc-DTPA and MDRD equation
99mTc-DTPA(
r=0.831
(p<0.0001)
/min)
㎖
MDRD(㎖/min/1.73㎡)
Results
Relationship between C-G and MDRD equation
C-G( /min1.73 )
r=0.933
(p<0.0001)
㎖
㎡
MDRD(㎖/min/1.73㎡)
Results
Comparison of Glomerular Filtration Rates Measured
by Different Methods According to the Degree of Renal Fuction
Scr
(㎎/㎗)
N
<1.5
105
99mTc-DTPA
(㎖/min)
C-G equation
(㎖/min/1.73㎡)
MDRD equation
(㎖/min/1.73㎡)
79.0±28.1
97.9±39.2
96.1±32.4
p<0.0001
p<0.0001
27.9±11.3
27.7±11.3
p=0.181
p=0.127
9.7±2.9
8.2±2.8
p<0.0001
p<0.0001
p
1.5-4.0
55
30.2±15.3
p
4.0<
57
15.3±8.4
p
* p : paired t-test
Results
120
97.9 96.1
100
80
79.0
60
40
30.2 27.9 27.7
20
15.3
9.7 8.2
0
<1.5
Tc-99m DTPA
1.5-4.0
C-G equation
4.0<
MDRD equation
Conclusion
99mTc-DTPA(Gates)
C-G equation
MDRD equation
Renal
Function
혈청 크레티닌 농도
신기능의 정도에 따른
사구체 여과율 평가
Conclusion
Jaffe 반응법
효소 반응법
(Alkaline picrate 방법)
(Enzymatic method)
Creatinine
(성별, 나이, 체중, 근육량
인종, 비만도, 육류섭취 등)
Cystatin C
(13kDa 저분자량 단백질)
C-G equation : 제지방체중(lean body weight)이 아닌 총 체중 사용