静脉肾盂造影与肾盂尿成分浓度之间的相关性研究
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摘要
目的:通过研究肾盂尿中的成分与静脉肾盂造影的积水等级和积水肾的病程之间的关系,探讨静脉肾盂造影(IVP)的积水等级和积水肾的病程与积水肾的肾功能之间的关系。
方法:对32例单侧上尿路不完全性梗阻所致肾积水的病例行静脉肾盂造影和逆行尿路造影检查;分别取其患肾的肾盂尿和膀胱尿,进行钠离子、镁离子、氯离子、钾离子以及内皮素(ET)、尿微量白蛋白、尿β_2-微球蛋白和尿肌酐的浓度以及尿的酸碱度和电导率的测定;对比分析肾盂尿的成分、膀胱尿的成分、病程以及静脉肾盂造影等级之间的关系。
结果:1、患肾肾盂尿的成分的浓度均大于膀胱尿的各成分的浓度,有统计学差异(p＜0.05)。2、积水肾肾功能受损早期的病例的肾盂尿的成分的浓度大于积水肾肾功能晚期的病例(p＜0.05)。3、积水程度1级的病人的钠、钾、氯离子的浓度是明显增高,方差分析统计有显著性差异。两两比较,2级、3级和4级间差别不明显。4、仅肾盂尿的pH的值的大小与病史和积水的等级间有相关性(p＜0.05),其相关系数分别为:0.45和0.40。
结论:1、肾积水早期或轻度积水的肾小管的浓缩功能增强,有利于减少管内压力,保持肾小管内液体流动,同时也维持一定的肾小球的滤过率。这是一种代偿反应。肾盂尿离子浓度增高,表明肾脏仍处于代偿反应阶段。而在肾积水的晚期或积水程度严重受损的情况下,肾脏不能代偿,肾小管内压力增高,肾盂尿内离子浓度降低,提示肾小管的浓缩功能明显降低,肾小球的滤过率降低,肾功能严重受损。对于上尿路梗阻致肾积水的病人,定期测定肾盂尿成分的浓度可以观察肾小管浓缩功能状况,预测和评价肾功能。2、肾盂尿的pH值与病程和积水等级间存在着线性相关关系。pH越大,肾盂尿的碱性程度越高,肾小管泌氢功能越差。本研究表明测定肾盂尿pH值可以评价肾脏的功能状况。3、IVP既可反应肾脏滤过功能,也能评价肾小管的再吸收功能。在评价肾功能时,应该更多考虑IVP显影的浓和淡。4、在评价肾功能方面,以IVP积水程度和显影浓淡作指标外,也应当考虑测定。肾盂尿离子和生物活性物质的浓度,使评价更为准确。
Objective:To explore the relation between intravenous phelogram(IVP)and renal function of hydronephrotic kidney by researching the correlation of the class of IVP and the constituent concentration of urine in the pelvis of ureter
Methods:Thirty-two patients with partial unilateral ureteral obstruction were examined by IVP and we collected the urine in the hydronephrotic pelvis of ureter。We measured the constituent concentration of urine in the pelvis of ureter which contained sodium ion、magnesium ion、chloridion、chloridion、endothelin(ET)、urinary albumin、urinaryβ2-microglobulin and creatinine.And then we analysis the relation among the constituent concentration of urine in the pelvis of ureter、case history and IVP
Results:(1)The constituent concentration of urine in the hydronephrotic pelvis of ureter were bigger than of cystic's urine.(2)The hydronephrotic patients' constituent concentration of urine in the pelvis of ureter with shorter case history were bigger than the patients' with longer case history.(3)The hydronephrotic patients' constituent concentration of urine in the pelvis of ureter with greater grade of IVP were bigger than the patients' with smaller grade of IVP.(4)Only power of hydrogen hydrogenion concentration(PH)had correlation with the case history and the grade of IVP and the coefficient correlation respectively was 0.45 and 0.40
Conclusion:(1)Urine concentration ability of nephric tubule is augmented in early stage/mild hydronephrosis.It is benefit for reducing the pressure of nephric tubule.This could keep the fluid flow and keep some glomerular filtration rate(GFR).All is a kind of compensatory action.The increasing of uric ion concentration of renal pelvis shows that the kidney is in the stage of compensatory action.But in late stage/severe hydronephrosis,the pressure of nephric tubule will be increasing and the decreasing of uric ion concentration of renal pelvis shows that the urine concentration ability of nephric tubule is obviously weak and GFR is low.Renal function is acutely injured.We can regularly measure uric concentration of renal pelvis of hydronephrotic patients by upper urinary tract obstruction to prognosis and appraise renal function.(2)PH has linear correlation with the case history and the grade of IVP.The bigger pH is,the higher alkalinity of urine of renal pelvis is.That means the function of secreting hydrogen is weaker.Our research shows the value pH can appreciate the renal function.(3)IVP can not only show the renal filtration function,but also can appreciate the renal filtration function.So we should consider the dense and light of the IVP's images when appreciating the renal function.(4)In aspect of appreciating the renal function,we also should consider measuring the uric ion and bioactive substance concentration of renal pelvis.
方法:对32例单侧上尿路不完全性梗阻所致肾积水的病例行静脉肾盂造影和逆行尿路造影检查;分别取其患肾的肾盂尿和膀胱尿,进行钠离子、镁离子、氯离子、钾离子以及内皮素(ET)、尿微量白蛋白、尿β_2-微球蛋白和尿肌酐的浓度以及尿的酸碱度和电导率的测定;对比分析肾盂尿的成分、膀胱尿的成分、病程以及静脉肾盂造影等级之间的关系。
结果:1、患肾肾盂尿的成分的浓度均大于膀胱尿的各成分的浓度,有统计学差异(p＜0.05)。2、积水肾肾功能受损早期的病例的肾盂尿的成分的浓度大于积水肾肾功能晚期的病例(p＜0.05)。3、积水程度1级的病人的钠、钾、氯离子的浓度是明显增高,方差分析统计有显著性差异。两两比较,2级、3级和4级间差别不明显。4、仅肾盂尿的pH的值的大小与病史和积水的等级间有相关性(p＜0.05),其相关系数分别为:0.45和0.40。
结论:1、肾积水早期或轻度积水的肾小管的浓缩功能增强,有利于减少管内压力,保持肾小管内液体流动,同时也维持一定的肾小球的滤过率。这是一种代偿反应。肾盂尿离子浓度增高,表明肾脏仍处于代偿反应阶段。而在肾积水的晚期或积水程度严重受损的情况下,肾脏不能代偿,肾小管内压力增高,肾盂尿内离子浓度降低,提示肾小管的浓缩功能明显降低,肾小球的滤过率降低,肾功能严重受损。对于上尿路梗阻致肾积水的病人,定期测定肾盂尿成分的浓度可以观察肾小管浓缩功能状况,预测和评价肾功能。2、肾盂尿的pH值与病程和积水等级间存在着线性相关关系。pH越大,肾盂尿的碱性程度越高,肾小管泌氢功能越差。本研究表明测定肾盂尿pH值可以评价肾脏的功能状况。3、IVP既可反应肾脏滤过功能,也能评价肾小管的再吸收功能。在评价肾功能时,应该更多考虑IVP显影的浓和淡。4、在评价肾功能方面,以IVP积水程度和显影浓淡作指标外,也应当考虑测定。肾盂尿离子和生物活性物质的浓度,使评价更为准确。
Objective:To explore the relation between intravenous phelogram(IVP)and renal function of hydronephrotic kidney by researching the correlation of the class of IVP and the constituent concentration of urine in the pelvis of ureter
Methods:Thirty-two patients with partial unilateral ureteral obstruction were examined by IVP and we collected the urine in the hydronephrotic pelvis of ureter。We measured the constituent concentration of urine in the pelvis of ureter which contained sodium ion、magnesium ion、chloridion、chloridion、endothelin(ET)、urinary albumin、urinaryβ2-microglobulin and creatinine.And then we analysis the relation among the constituent concentration of urine in the pelvis of ureter、case history and IVP
Results:(1)The constituent concentration of urine in the hydronephrotic pelvis of ureter were bigger than of cystic's urine.(2)The hydronephrotic patients' constituent concentration of urine in the pelvis of ureter with shorter case history were bigger than the patients' with longer case history.(3)The hydronephrotic patients' constituent concentration of urine in the pelvis of ureter with greater grade of IVP were bigger than the patients' with smaller grade of IVP.(4)Only power of hydrogen hydrogenion concentration(PH)had correlation with the case history and the grade of IVP and the coefficient correlation respectively was 0.45 and 0.40
Conclusion:(1)Urine concentration ability of nephric tubule is augmented in early stage/mild hydronephrosis.It is benefit for reducing the pressure of nephric tubule.This could keep the fluid flow and keep some glomerular filtration rate(GFR).All is a kind of compensatory action.The increasing of uric ion concentration of renal pelvis shows that the kidney is in the stage of compensatory action.But in late stage/severe hydronephrosis,the pressure of nephric tubule will be increasing and the decreasing of uric ion concentration of renal pelvis shows that the urine concentration ability of nephric tubule is obviously weak and GFR is low.Renal function is acutely injured.We can regularly measure uric concentration of renal pelvis of hydronephrotic patients by upper urinary tract obstruction to prognosis and appraise renal function.(2)PH has linear correlation with the case history and the grade of IVP.The bigger pH is,the higher alkalinity of urine of renal pelvis is.That means the function of secreting hydrogen is weaker.Our research shows the value pH can appreciate the renal function.(3)IVP can not only show the renal filtration function,but also can appreciate the renal filtration function.So we should consider the dense and light of the IVP's images when appreciating the renal function.(4)In aspect of appreciating the renal function,we also should consider measuring the uric ion and bioactive substance concentration of renal pelvis.
引文
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[3]史继红.尿路梗阻对肾功能的影响.职业与健康,2004,20(3):112-113
[4]张一蔚.静脉尿路造影对泌尿系疾病的应用价值研究.中外医用放射技术杂志.1999,04:1
[5]罗开玲,王晓平等,梗阻性IVP不显影无功能肾脏的预后因素评价(附21例报告).广西医科大学学报,2001,18(3):378-380
[6]肖亚景,唐静,刘长江等.~(99m)TC-DTPA肾动态显像与静脉肾盂造影评价肾功能的比较.Journal of Chinese physician,Aprial,2005,7(4):474-475
[7]王志纯,张德昌.临床军医杂志.2001,29(3):31-34
[8]Itano NB,Sherrill LE,Lerman LO et al.Electron beam computerized tomography assessment of in vivo single kidney glomerular filtration rate and tubular dynamics during chronic partial unilateral obstruction in the pig.J Urol 2001,51:510
[9]Iekuni Ichikawa,Barry M.Brenner Mechanism of Inhibition of Proximal Tubule Fluid Reabsorption after Exposure of the Rat Kidney to the PHysical Effects of Expansion of Extracellular Fluid Volume.Clin Invest.,1979,64(5):1466-1474,
[10]Pelaze LI,Juncos LA,Stulak J,et al.Non-invasive evaluation of bilateral renal regional blood flow and tubular dynamics during actue unilateral obstruction.Nephrology Dialysis Transplantion.2005,20(1):83
[11]Nielsen S,Kwon TH,Christensen BM,et al.Physiology and pathophysiology of renal aquaporins.J Am Soc Nephrol.1999,10:647
[12]Stenberg.Renal interstitial pressure and tubuloglomerular feedback control in rats during infusion of atrial natriuretic peptide(ANP).Acta PHysiol Scand.1992,146(3):393-8
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