8种eGFR估算方程评价心血管病患者肾小球滤过率的诊断价值比较  

Comparison of eight equations for estimating glomerular filtration rate in patients with cardiovascular diseases

作　　者：苏亮[1,2] 白书昌 Bundhoo Kaviraj 黄铮[1] 侯玉清[1] 任昊[3,2] 许顶立[1,2] 

机构地区：[1]南方医科大学南方医院心内科,广东广州510515 [2]南方医科大学南方医院教育部"器官功能衰竭防治"省部共建重点实验室,广东广州510515 [3]南方医科大学南方医院肾内科,广东广州510515

出　　处：《南方医科大学学报》2011年第7期1220-1223,共4页Journal of Southern Medical University

基　　金：广东省教育厅"211工程"资助项目;广东省自然科学基金(8151051501000048)

摘　　要：目的比较8种估算的肾小球滤过率（eGFR）估算方程评价心血管病患者GFR的诊断价值。方法选择以99m↑Tc-DTPA肾动态显像法进行GFR检测的208例患者,测量血浆Cr、Cys-C并使用各种eGFR估算方程计算出相应eGFR。结果 （1）在慢性肾脏病（CKD）13期,Scr-eGFR估算方程与同位素GFR的相关性明显高于Cys-eGFR估算方程,在CKD4、5期,Cys-eGFR估算方程与GFR相关性略高于Scr-eGFR估算方程。（2）MDRD、简化MDRD会高估CKD4、5期患者GFR,Rule方程在CKD1、2期患者出现低估,Macisaac方程在CKD25期均高估GFR,Tan方程则在CKD2、3期出现高估。（3）轻度肾衰竭患者Scr-eGFR估算方程的ROC曲线下面积（AUC^ROC）高于Cys-eGFR估算方程,中度肾衰竭患者Scr-eGFR估算方程的AUC^ROC与Cys-eGFR估算方程并无明显差异,而重度肾衰竭患者Cys-eGFR估算方程的AUCROC高于Scr-eGFR估算方程。（4）与99m↑Tc-DTPA肾动态显像法测定的GFR参考值相比较,各CKD分期均无明显差异的eGFR评估方程有：基于Scr的改良MDRD方程和基于Cys-C的Arnal-Dade方程。结论改良MDRD方程（或简化MDRD方程）和Arnal-Dade方程更适于国内心血管病患者eGFR的评估。Objective To assess the diagnostic value of 8 equations using different variables for determining the estimated glomerular filtration rate（eGFR） in patients with cardiovascular diseases.Methods GFR was estimated in 208 patients with cardiovascular diseases by 99m↑ Tc-DTPA dynamic renal imaging,and the eGFR was derived from 8 equations using different variables.Results In patients with chronic kidney disease（CKD） stages 1-3,the eGFR calculated suing serum creatinine（SCr）-based equation was better correlated to GFR estimated by 99m Tc-DTPA renal imaging than that derived from cystatin C（Cys C）-based equations,whereas in patients with CKD stages 4 and 5,the estimates by the latter equation showed a better correlation to GFR.Compared with 99m Tc-DTPA renal imaging,MDRD-based equation and simple MDRD equation resulted in a higher eGFR in patients with CKD stages 4 and 5,the Rule equation had a lower eGFR in CKD stages 1 and 2,the Macisaac equation yielded a higher eGFR in CKD stages 2-5,and the Tan equation showed a higher eGFR in CKD stages 2 and 3.In patients with mild renal dysfunction,the Scr-based equation had a higher AUC ROC than Cys C-based equation,which was reversed in patients with severe renal dysfunction;the AUC ROC of the two equations were comparable in patients with moderate renal dysfunction.Compared with 99m ↑Tc-DTPA renal imaging,the modified MDRD equation and Arnal-Dade equation showed no significant difference in the eGFR in patients with CKD stages 1-5.Conclusion Modified MDRD equation（or simple MDRD equation） and Arnal-Dade equation are superior to other calculation methods for estimating the GFR in Chinese patients with cardiovascular disease.

关 键 词：肾小球滤过率评估方程 99↑mTc-DTPA肾动态显像法 心血管疾病 慢性肾脏病 肾小球滤过率 

分 类 号：R54[医药卫生—心血管疾病] R692[医药卫生—内科学]