肾小球滤过率评估方程对老年慢性肾脏病患者适用性的评价  

The application of glomerular filtration rate estimating equations in elderly patients with chronic kidney disease

作　　者：刘迅[1] 王成[1] 唐骅[1] 陈珠江[1] 叶增纯[1] 娄探奇[1] 

机构地区：[1]中山大学附属第三医院肾内科,广州510630

出　　处：《中华老年医学杂志》2009年第8期640-644,共5页Chinese Journal of Geriatrics

摘　　要：目的评价肾小球滤过率（GFR）评估方程在老年慢性肾脏病（CKD）患者的适用性。方法选择老年CKD患者103例，采用Cockcroft-Gault（CG）方程、MDRD1方程、简化MDRD方程、Jelliffe1973（JE73）方程、Mawer（MA）方程、Hull（HU）方程、Jellife1971（JE71）方程、血肌酐倒数公式、Gate（GA）方程、Biornsson（BJ）方程，分别预测GFR值，与^99mTc DTPA肾动态显像检测的GFR（sGFR）进行比较。结果Bland—Altman分析显示，CG方程、BJ方程和HU方程估计的GFR与sGFR的一致性较好，但所有各方程估计的GFR与sGFR的一致性限度均超过事先规定的专业界值。线性回归结果显示，JE方程和CG方程估测的GFR与x轴的斜率较其他方程更接近0，MDRD1方程较其他方程有较小的偏差；在所有方程中，BJ方程、JE方程和CG方程GFR符合率较高。在CKD的不同分期中，BJ方程、CG方程和JE方程具有较小的偏差和更优的准确性。结论当血肌酐的测定方法为酶法时，如果直接应用目前临床常用的GFR评估方程预测老年CKD患者的GFR，可能会产生明显的偏差。Objective To evaluate the applicability of glomerular filtration rate estimation equations in elderly Chinese patients with chronic kidney disease（CKD）. Methods A total of 103 elderly CKD patients were investigated. Glomerular filtration rate （GFR） was estimated by Cockcroft -Gault equation, MDRD1 equation, abbreviated MDRD equation, Jellife 1973 equation, Mawer equation, Hull equation, Jellife 1971 equation, plasma creatinine reciprocal equation, Gate equation and Bjornsson equation. The accuracy of estimated GFRs was compared with that of GFR estimated by 99mTc-DTPA-GFR （sGFR）in elderly CKD patients. Results Bland-Altman analysis demonstrated that GFRs evaluated by Cockcroft -Gault equation, Bjornsson equation and Hull equation were more consistent with sGFR than the other equations. But all the equations were not well consistent with sGFR. Linear regression showed that the slopes of Jellife 1973 equation and Cockcroft- Gault equation were closer to the identical line. Bias of MDRD1 equation was smaller. Accuracy of Bjornsson equation, Jellife 1973 equation and Cockcroft Gault equation were higher than the other equations. When comparing the bias as well as accuracy of estimated GFRs with sGFR in different stages of CKD, GFR estimated by Bjornsson equation, Cockcroft-Gault equation and Jellife1973 equation showed better results. Conclusions When plasma creatinine is checked by enzymatic method, GFR estimating equations may show great bias in elderly Chinese CKD patients.

关 键 词：肾功能不全 慢性 肾小球滤过率 技术评估 生物医学 

分 类 号：R686[医药卫生—骨科学]