肾小球滤过率评估公式的准确性比较  

The accuracy comparison and the clinic value of the glomerular filtration rate estimated by equations

作　　者：孙倩倩[1] 谈敏[1] 常虹[1] 

机构地区：[1]安徽医科大学附属省立医院,安徽省立医院老年病科,合肥230001

出　　处：《中国临床保健杂志》2010年第4期357-360,共4页Chinese Journal of Clinical Healthcare

基　　金：2009年安徽省卫生厅青年科研基金资助(09B131)

摘　　要：目的评估Cockcroft-Gault(C-G)公式,简化MDRD公式对中国糖尿病患者肾功能估算的准确性。方法以99mTC-DTPA同位素测定的肾小球滤过率(GFR)为参考标准,分别用C-G公式和简化MDRD公式估算GFR(eGFR),与同位素测定结果进行比较,并进行一致性检验,评价估算公式的准确性。结果 (1)210例糖尿病患者(1型糖尿病12例,2型糖尿病198例),年龄(56.5±13.7)岁,体质量(68.1±10.9)kg,体质量指数(BMI)(24.6±3.4)kg/m2,血肌酐(76.9±34.3)μmol/L;(2)同位素测定GFR值为(85.2±25.0)ml·min-1·1.73m-2,C-G公式估算值为(97.0±37.2)ml·min-1·1.73m-2,简化MDRD公式估算值为(104.1±37.1)ml·min-1·1.73m-2;(3)C-G公式估算值与GFR的差值中位数为-6.47ml·min-1·1.73m-2,简化MDRD公式估算值与GFR的差值中位数为-16.5ml·min-1·1.73m-2;(4)相关性分析表明,实测GFR与年龄、病程、BMI、BUN、Cr、尿白蛋白比肌酐呈负相关;与身高、体质量、HbA1c无相关性;而CG公式估算的GFR与年龄,病程、BUN、Cr、尿白蛋白比肌酐呈负相关,与身高、体质量、HbA1c呈正相关,与BMI无相关性;MDRD公式估算的GFR与年龄、病程、BUN、Cr、尿白蛋白比肌酐呈负相关,与身高、HbA1c呈正相关,与体质量、BMI无相关性。(5)一致性检验分析表明,C-G公式Kappa值为0.554,MDRD公式Kappa值为0.646。结论与参考标准比较,两估算公式对于糖尿病患者肾功能的估算结果均不是非常理想;相比之下,MDRD公式的准确性优于C-G公式。Objective To evaluate the accuracy of Cockcroft-Gault（ C-G） and simplified MDRD equations in estimating the glomerular filtration rates（ GFR） in Chinese diabetes mellitus patients. Methods GFR measured by radiolabeled diethylenetriaminepentaacetic acid （ 99mTc-DTPA） was used as the reference standard. Serum creatinine and body weight were used to estimate GFR （ eGFR） by C-G equation and simplified MDRD equation respectively. eGFRs were compared with measured GFR. The agreements between them were evaluated by kappa statistics. Results Two hundred and seventeen diabetes mellitus patients aged （ 56. 54 ± 13. 70） years were enrolled in this study. The body weight was（ 68. 06 ±10. 85） kg and the serum creatinine was（ 76. 87 ±34. 25） μmol/L. The measured GFR was（ 85. 18 ± 24. 96） ml·min ^-1·1. 73m^ -2. The eGFR from C-G equation （ eGFR1） was （ 97. 04 ±37. 15） ml·min ^-1·1. 73m^ -2. The eGFR fron simplified MDRD equation （ eGFR2） was（ 104. 09 ± 37. 14） ml·min ^-1·1. 73m^ -2. The median bias was-6. 47 ml·min ^-1·1. 73m^ -2 （ P） between eGFR1 and measured GFR,and was -16. 51ml·min ^-1 ·1. 73m^ -2 between eGFR2 and measured GFR. Spearman correlation analysis showed good correlation between measured GFR and eGFRs. For C-G equation,the Kappa value was 0. 554. For simplified MDRD equation,the Kappa value was 0. 646. Conclusion Compared with the reference standard,both of equations show a low accuracy. The simplified MDRD equation is better than C-G equation in estimating GFR among diabetic patients.

关 键 词：肾小球滤过率 数学计算 糖尿病 

分 类 号：R446.1[医药卫生—诊断学]