不同的基于血肌酐估测肾小球滤过率公式对健康成年人肾功能的评价  

Evaluation of four equations based on serum creatinine to estimate glomerular filtration rate in a healthy adult population

作　　者：孔祥雷[1] 张成银[2] 马小静 唐利军[1] 王尊松[1] 贾晓妍[1] 陈萍[1] 魏勇[1] 张莹[1] 李文斌[1] 崔美玉[1] 许冬梅[1] 

机构地区：[1]山东大学附属千佛山医院肾内科,济南250014 [2]潍坊医学院附属益都中心医院肾内科 [3]山东电力中心医院妇科

出　　处：《中华检验医学杂志》2013年第3期242-245,共4页Chinese Journal of Laboratory Medicine

摘　　要：目的研究不同的基于血肌酐估测肾小球滤过率（eGFR）公式对健康成年人肾功能的评价。方法本研究为横断面研究。选取2009年1月至2011年12月在山东大学附属千佛山医院健康管理中心查体的841名健康成年人，应用CKD—EPI两种族及四种族公式、中国人校正的MDRD公式（Chi—MDRD）、简化MDRD公式估测eGFR。应用Skewness偏度和Kurtosis峰度评估eGFR的分布，并用Bland-Altman曲线进行一致性检验，Kappa检验判断不同公式对eGFR分期的一致性。结果CKD-EPI两种族及四种族公式的eGFR（Skewness偏度分别为0．11和0．12，Kurtosis峰度分别为-0．41和-0．37）比Chi—MDRD公式和简化MDRD公式的eGFR（Skewness偏度分别为1．63和1．67，Kurtosis峰度分别为5．22和5．73）更趋于正态分布。在eGFR范围为60～89ml·min^-1·（1．73m^2）^-1的肾功能下降组，应用简化MDRD公式有51．5％（433／841）的研究对象被划分为“肾功能下降组”；在eGFR≥150ml·min^-1·（1．73m^2）^-1的高滤过组，应用Chi—MDRD公式有4．3％（36／841）的研究对象被划分为“高滤过组”。CKD-EPI两种族及四种族公式eGFR一致性好，但CKD—EPI两种族eGFR比四种族eGFR平均低5．3ml·min^-1·（1．73m^2）^-1。CKD—EPI两种族及四种族公式在eGFR≥150，120～149，90～119，60—89ml·min^-1·（1．73m^2）^-1组的符合率分别为25．0％（1／4）、52．5％（94／179）、86．5％（453／524）和100％（134／134）（Kappa=0．65，95％CI：0．62～0．68），提示两公式的eGFR的分期一致性好。结论与Chi—MDRD公式及简化MDRD公式相比较，CKD—EPI两种族及四种族公式的eGFR分布更合理，且2个公式对eGFR的估测表现相似。（中华检验医学杂志，2013，36：242-245）Objective To evaluate of four equations based on serum creatinine to estimate glomerular filtration rate （eGFR） in a healthy adult population. Methods A cross-sectional study of 841 Chinese healthy adults who visited the Health checkup Clinic consecutively in our hospital were enrolled, eGFRs were calculated by the Chronic Kidney Disease Epidemiology Collaboration （CKD-EPI） twolevel race equation, the CKD-EPI four-level race equation, the Modification of Diet in Renal Disease （MDRD） equation and the Chinese modification of the MDRD Study equation （Chinese equation）,respectively. The Bland-Ahman method and Kappa test were used for comparing the agreement between two different equations to eatimate GFR. Results The CKD-EPI two-level race and the four-level race equation showed a Gaussian distribution compared with the Chinese equation and the MDRD equation, whose Skewness were 0. 11 and 0. 12 versus 1.63 and 1.67, the Kurtosis were - 0.41 and - 0. 37 versus 5.22 and 5.73, respectively. The MDRD equation made the percentage of eGFR 60-89 ml · min^-1·（1.73 m^2）^-1 51.5% （433/841） and the Chinese equation made the percentage of eGFR ≤150 ml ≤ min^-1 ·（1. 73 m^2）^-1 4. 3% （36/841）, respectively. Mean eGFR was 5.3 ml·min^-1·（1.73 m^2）^-1 lower with the CKD-EPI two-level race equation as compared to the CKD-EPI four-level race equation. The percentage of GFR staging concordance between the CKD-EPI two-level race and the four-level race equations for eGFR≥150, 120 - 149, 90-119, 60-89 ml ≥ min^-1· （1.73 m^2）^-1 was 25.0% （1/4）, 52.5% （94/179）, 86.5% （453/524）, and 100% （134/134）, respectively. Kappa index was 0. 65 and the 95% confidence interval was 0. 62 to 0. 68. Conclusions The CKD-EPI two-level race equation and the four-level race equation perform similarly, and both of them seem to eatimate a reasonable distribution of eGFR in Chinese healthy adult population. （ Chin J Lab Meal,2013,36：242-245）

关 键 词：肾小球滤过率 肌酸酐 算法 成年人 评价研究 

分 类 号：R692[医药卫生—泌尿科学]