五种肾小球滤过率评估方程在良性小动脉肾硬化症中的应用  

Comparison of five equations to estimate glomerular filtration rate in patients with benign arteriolar nephrosclerosis.

作　　者：谢志斌[1,2] 史伟 刘双信[2] 梁馨苓[2] 王文健[2] 叶智明[2] 章斌[2] 梁永正[2] 马建超[2] 徐丽霞[2] 徐卫平[2] 

机构地区：[1]南方医科大学,广州510515 [2]广东省人民医院肾内科广东省医学科学院,广州510080

出　　处：《岭南心血管病杂志》2013年第2期201-204,共4页South China Journal of Cardiovascular Diseases

基　　金："十二五"国家科技支撑计划课题(项目编号:201211)

摘　　要：目的比较经体表面积校正后Cockcroft-Gault(CG)、美国肾脏病膳食改良实验(modification of diet inrenal disease,MDRD)、美国简化MDRD、中国MDRD、中国简化MDRD方程在良性小动脉肾硬化症患者中预测肾小球滤过率(glomerular filtration rate,GFR)的适用性。方法选取2010年2月至2011年11月在广东省人民医院确诊为良性小动脉肾硬化症的患者140例为研究对象,以双血浆法99mTc-DTPA血浆清除率为GFR参考值,将各方程的估算GFR与双血浆法所测的结果进行对比分析。结果双血浆法所测的GFR值为(39.3±22.3)mL.min-1.1.73 m-2。校正后CG、MDRD、美国简化MDRD方程均低估(-6.90、-3.48、-2.59 mL.min-1.1.73m-2)实际GFR,而中国MDRD、中国简化MDRD方程均高估(4.07、5.96 mL.min-1.1.73 m-2)实际GFR;MDRD方程偏离度(363.16任意单位)明显小于其他方程(876.24、1 267.12、483.82、1 516.90任意单位),并且精密度、30%准确性明显优于中国MDRD、中国简化MDRD方程,差异有统计学意义(P<0.05)。结论以上各估算GFR方程对良性小动脉肾硬化症患者适用性均欠佳,鉴于MDRD方程偏离度、精密度、准确性的优越性,选用MDRD方程可能更加合适。Objectives To compare the applicability of five equations [ Cockcroft-Gauh （CG） adjusted for body surface area, original modification of diet in renal disease （MDRD）, American abbreviated MDRD, Chinese modified MDRD and Chinese abbreviated MDRD） to estimate glomerular filtration rate （GFR） in patients with benign arteriolar nephrosclerosis. Methods Totally 140 patients diagnosed with benign arteriolar nephrosclerosis in Guangdong General Hospital from February 2010 to November 2011 were enrolled in this study. Plasma clearance measured by dual plasma sampling 99mTc-DTPA method was taken as a reference GFR. GFRs estimated by the five equations were compared to the reference GFR. Results Reference GFR measured by dual plasma sampling 99mTc-DTPA method was （39.3± 22.3 ）mL. min-1. 1.73 m-2. CG adjusted for body surface area, original MDRD, American abbreviated MDRD equations underestimated the reference GFR （-6.90,-3.48, -2.59 mL. rain-1. 1.73 m-2, respectively）. Chinese modified MDRD and Chinese abbreviated MDRD equations overestimated the reference GFR （4.07, 5.96 mL .min-1. 1.73 m-2, respectively）. Compared with the other equations, the deviation of original MDRD equation （363.16, arbitrary units） was much smaller （CG adjusted for body surface area 876.24, American abbreviated MDRD 1 267.12, Chinese modified MDRD 483.82, Chinese abbreviated MDRD 1 516.90, arbitrary units）. The precision and 30% accuracy of original MDRD equation was significantly higher than those of Chiense modified MDRD and Chinese abbreviated MDRD equations（ P〈0.05 ）. Conclusions No equations mentioned above shows satisfactory performance for estimating GFR in patients with benign arteriolar nephrosclerosis. Compared with the other equations, the original MDRD equation may be more suitable to be used in patients with benign arteriolar nephrosclerosis for estimating GFR.

关 键 词：肾硬化症 小动脉 肾小球滤过率 方程 

分 类 号：R543.5[医药卫生—心血管疾病]