临床常用肾小球滤过率评估方程在2型糖尿病患者中的效能比较  

Comparison of effectiveness of estimated glomerular filtration rate equations in patients with type 2 diabetic kidney disease

作　　者：李明[1] 陈慧卿[2] 刘迅[1] 唐骅[1] 王成[1] 李灿明[1] 赵文波[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 [2]中山大学附属第一医院儿科

出　　处：《中华糖尿病杂志》2012年第6期334-339,共6页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：广东省科技计划项目（20118031800084）

摘　　要：目的评价目前临床常用的肾小球滤过率（GFR）评估方程在2型糖尿病患者中的准确性和适用性。方法入选2007年10月至2010年12月在广州中山大学附属第三医院肾内科及内分泌科住院的2型糖尿病患者224例，其中男133例，女91例，平均年龄（60±13）岁。测定血清肌酐和胱抑素C水平，以体表面积标化的锝-二乙三胺五乙酸（^99mTcDTPA）测得的GFR（sGFR）为标准，采用肾脏病膳食改良试验方程（MDRD）、中国方程、Cockcroft—Gault方程、慢性肾脏病流行病合作组方程（EPI方程）、瑞金方程、慢性肾脏病流行病合作组胱抑素方程（EPI—Cysl方程及EPI-Cys2方程）以及MacIsaac胱抑素方程估测GFR值。应用Bland—Altman分析、线性相关分析及受试者工作特征曲线进行数据统计。结果（1）Bland—Altman分析显示，EPI—Cysl方程、EPI—Cys2方程及MacIsaac胱抑素方程估测的GFR与sGFR的一致性最好，所有方程估测的GFR与sGFR的一致性限度均超过预定的界值；EPI．Cysl方程、EPI—Cys2方程及MacIsaac胱抑素方程与x轴的斜率分别为0．168、0．183、0．186；MacIsaac胱抑素方程与Y轴的截距最小。（2）胱抑素C推导的3个方程偏差较小，30％符合率达60％以上，50％符合率达85％；EPI．Cysl方程和EPI-Cys2方程低估GFR，血肌酐推导的5个方程高估GFR。（3）诊断慢性肾病的效能方面，EPI—Cysl方程及EPI-Cys2方程的准确性和敏感度较高（分别为88％和94％），MacIsaac胱抑素方程和瑞金方程的截点值分别为62．4、64．9ml·min-1·1．73m-1，与原分割点（60ml·min-1·1．73m-2）吻合度较高。结论8个GFR方程估算的GFR均存在不同程度的误差，胱抑素C推导方程总体效能高于血肌酐推导方程，瑞金方程在血肌酐推导方程中效能较高。在今后广泛用于临床前，所有方程仍需进一步进行校正。Objective To evaluate the effectiveness of estimated glomerular filtration rate （eGFR） equations in patients with type 2 diabetic kidney disease. Methods A total of 224 patients with type 2 diabetes mellitus （male 133, female 91, average age （60 ± 13 ） y） who were treated during October 2007 and December 2010 in the Third Affiliated Hospital of SUN Yat-sen University were enrolled in this study. Serum creatinine （Scr） and cystadin-C （cysC） were tested, eGFR was calculated with abbreviated Modification of Diet in Renal Disease （MDRD） equation, Chinese equation, Cockcroft-Gauh equation, Chronic Kidney Disease Epidemiology Collaboration （CKD-EPI） equation, Ruijin equation, EPI-Cysl equation, EPI-Cys2 equation and Maclsaac equation, respectively, and compared with 99mTe-DTPA-GFR （sGFR） by Bland-Ahman analysis, Pearson correlation and receiver operator characteristic （ROC） curve. Results （ 1 ） In Bland-Altman analysis, consistency of EPI-Cysl, EPI-Cys2 and Maclsaac equations with sGFR was better than other equations, and all eGFRs were above the limit point. The slopes of EPI-Cysl, EP1-Cys2 and Maelsaac equations were 0. 168, 0. 183, and 0. 186, respectively. The intercept of Maclsaae equation was smaller. （2） Bias of EPI-Cysl, EPI-Cys2 and Maclsaac equations were smaller than others. 30% or 50% accuracy rate of these three equations was above 60% and 85%. EPI-Cysl and EPI-Cys2 equations underestimated actual GFR and other Scr-based equations overestimated GFR. （3） As to diagnosis of diabetic kidney disease, EPI-Cysl and EPI-Cys2 equations were more sensitive （94%） and accurate （ 〉88% ）. The cut-point of MacIsaac and Ruijin equations were 62.4 and 64. 9 ml·min-1· 1.73 m-2, closer to 60 ml ·min-1 . 1.73 m-2. Conclusion All the equations shows bias in estimating actual GFR. Compared with the equations induced by Scr, CysC-based equations may be more accurate and efficient. All the equations should be amended when applying to patients with type 2 diabetes mell

关 键 词：糖尿病 2型 糖尿病肾病 肾小球滤过率 

分 类 号：R692[医药卫生—泌尿科学]