简化MDRD公式预测慢性肾病患者肾小球滤过率的应用评价及校正  

Evaluating and refitting the simplified equation of MDRD to predict glomerular filtration rate in Chinese patients with chronic kidney disease

作　　者：史浩[1] 陈楠[1] 张文[1] 任红[1] 徐耀文[1] 沈平雁[1] 王伟铭[1] 俞海瑾[1] 李晓[1] 冯晓蓓[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院肾脏内科,上海200025

出　　处：《中国实用内科杂志》2006年第5期665-669,共5页Chinese Journal of Practical Internal Medicine

基　　金：上海市卫生局重点课题(2003ZD002)

摘　　要：目的 评价对慢性肾脏病（CKD）患者采用简化“肾脏病膳食改良试验”（MDRD）公式预测肾小球滤过率（GFR）的适用性,并回归分析出适于国情的校正MDRD公式.方法选择2002-2005年上海交通大学医学院附属瑞金医院肾脏内科住院的760例CKD患者,所有患者同步检测^99mTc-GFR、血肌酐（Scr）等,并用简化MDRD和Cockcroft-Gault（CG）公式计算估测的GFR.比较不同CKD分期中MDRD、CG公式估测GFR的准确性.从上述患者中随机选取670例用于建立中国人群的校正MDRD方程,其余90例患者用于检验新建立的校正方程的准确性.结果 （1）MDRD与CG-GFR在CKD各期预测值均低估了GFR,但在CKD Ⅰ～Ⅲ期,MDRD预测值的偏离程度明显小于CG公式.（2）MDRD与CG公式的预测值,均在CKD Ⅰ～Ⅲ期中与^99mTc-GFR符合率高,而在CKDⅣ～Ⅴ期中符合率低.（3）本研究校正后的M-MDRD公式为：GFR=234.96×（Scr）^-0.926×（年龄）^-0.280×0.828（女性）.（4）相对原始简化MDRD及CG公式,在CKDⅡ～Ⅴ期患者中,M-MDRD减小了GFR预测值与实测值的偏差.提高了GFR预测值的15%或30%的符合率,尤其是将CKDⅣ～Ⅴ期中GFR预测值30%的符合率提高到接近或超过70%.结论简化的MDRD公式可在临床实践中简便、准确地估算GFR,但该公式用于中国CKD患者须进行校正.Objective To evaluate the applicability of the simplified equation of MDRD to predict glomerular filtration rate （GFR） from serum creatinine in Chinese patients with chronic kidney disease （ CKD）, and refit the MDRD equation parameter estimates with Chinese patients data. Methods A total of 760 hospitalized CKD patients were investigated from 2002 to 2005. Patients＇sex, age, height and body weight were recorded; plasma creatinine and ^99mTc - GFR （standardized by body surface area） were measured in all patients; GFR was estimated with simplified equation of MDRD and Cockcroft- Gault; the accurancy of estimated GFR with MDRD and CG were compared with^99mTc -GFR in different stage of CKD. Totally 670 patients were randomly selected as the training sample, the remaining 90 patients constituted the validation sample. We used stepwise multiple regression to refit the equation of MDRD and the regression models were developed by using the training sample. The refitting equation was then tested and compared with the other equation in the validation sample. Results （ 1 ） Both the MDRD and CG - GFR prediction equations seemd to systematically underestimate GFR, but the accurancy of MDRD equation was better than CG - GFR in stage Ⅰ - Ⅲ of CKD. （2） The bias of estimated GFR （MDRD or CG- GFR equation） with ^99mTc -GFR was lower in stage I - Ⅲ than in stage Ⅳ - Ⅴ of CKD. （3） Refitting of the MDRD equation parameter estimates to Chinese patients data set resuited in the following prediction equations： GFR =234.96 × （Scr） ^-0.956 × （Age）^ -0.280 ×0. 828 （Female）. （4）Comparing with^99m Tc - GFR, the bias of estimated GFR calculated by the refitting MDRD equation was lower than that of estimated with MDRD or CG especially in the stage Ⅳ - Ⅴ of CKD in Chinese patients. Conclusion the simplified equation of MDRD can estimate GRF accurately, but the equation must be refitted in Chinese patients.

关 键 词：肾小球滤过率 简化MDRD方程 评估和校正 慢性肾病 

分 类 号：R5[医药卫生—内科学]