血肌酐水平、MDRD-GFR、CG-GFR与肾小管间质病变相关性研究  

The relationship between the level of serum creatinine,MDRD-GFR,CG-GFR and renal tubulointerstitial lesion

作　　者：任丽[1] 蒋素华[1] 刘红[1] 丁小强[1] 宋凌燕[2] 许迅辉[1] 

机构地区：[1]复旦大学附属中山医院肾内科,上海200032 [2]复旦大学附属中山医院检验科,上海200032

出　　处：《检验医学与临床》2010年第22期2436-2438,共3页Laboratory Medicine and Clinic

基　　金：上海市重大课题(08DZ1900602);教育部国家"211工程"重点学科建设项目(三期)(211XK20)

摘　　要：目的探讨血肌酐(SCr)、估算肾小球滤过率(eGFR)水平与肾小管间质病变程度间的相关性。方法 2007年1月至2010年3月因体检异常来本院就诊且经肾活检确诊为肾脏病的357例患者,对他们的临床和病理资料进行回顾性分析。所有患者都检测SCr,并用肾脏病膳食改良试验(MDRD)和Cockcroft-Gault(CG)公式计算eGFR;病理学分级参照Katafuchi半定量积分标准。结果随肾小管间质形态学改变加重,SCr呈明显升高趋势,而CG-GFR、MDRD-GFR呈显著下降趋势,SCr、CG-GFR、MDRD-GFR均与小管间质病变存在显著相关(r=0.626,-0.596,-0.600;P<0.001)。SCr正常范围(<115μmol/L)时,90%以上的患者出现了不同程度的小管间质损伤,13.2%的患者出现了中重度小管间质病变;SCr水平和小管间质病变的相关性减弱;38.9%的患者出现了GFR异常(<90mL/min/1.73m2),与GFR正常(≥90mL/min/1.73m2)者相比,肾小管间质病变分级构成比有显著性差异。结论肾功能与肾小管间质的形态学改变既联系密切,又不完全平行。SCr异常时,对肾小管间质病变的辅助诊断价值较大;但当其在所谓正常范围时,需根据MDRD或CG方程估算GFR,这时GFR对小管间质病变有更好的预测性。Objective To study the relationship between the level of SCr and eGFR and the degree of tubulointerstitial injury. Methods From January 2007 to March 2010,357 patients were hospitalized due to physical abnormalities and diagnosed as kidney disease by renal biopsy,whose clinical and pathological data were retrospectively analyzed. SCr was detected in all patients,and the eGFR was calculated with MDRD and Cockcroft-Gault （CG） formula while the renal histopathology was quantified according to Katafuchi semi-quantitative standards. Results 174 patients were male,183 cases were female,with the average age of 41.3±14.3 years old.With the aggravation of tubulointerstitial injury,SCr level increased and eGFR decreased gradually. The degree of tubulointertitial lesion was showed positive correlation with SCr level,negative correlation with CG-GFR and MDRD-GFR（r=0.626,-0.596,-0.600; P all0.001）. When SCr was in the normal range （115 μmol/L）,90% of the patients had various degrees of tubulointerstitial damage,and 13.1% of the patients had moderate or severe tubulointerstitial lesions; the correlation between SCr level and tubulointerstitial damage became weak; the constitution of tubulointerstitial lesion classification in patients with abnormal GFR was significantly different from that in patients with normal GFR. Conclusion The changes of tubulointerstitial morphologic are closely linked with renal function,but incompletely parallel. Serum creatinine in the abnormal range could be used to diagnose tubulointerstitial injury well. However,when the level serum creatinine was in the so-called normal range,estimating GFR by the MDRD or Cockcroft-Gault equation was preferred to assess renal tubulointerstitial injury.

关 键 词：血肌酐 肾小球滤过率 肾小管间质病变 肾活检 

分 类 号：R446.1[医药卫生—诊断学]