老年人慢性肾脏病分期的研究  

Research on stage of chronic kidney disease in elderly patients

作　　者：陈莹[1] 秦明照[1] 郑洁[1] 颜虹[2] 李眉[3] 崔瑶[1] 张瑞华[1] 赵薇[1] 郭英[1] 

机构地区：[1]首都医科大学附属北京同仁医院干部医疗科,100730 [2]首都医科大学附属北京同仁医院干部检验科,100730 [3]首都医科大学附属北京同仁医院干部核医学00730

出　　处：《中华老年医学杂志》2013年第6期602-604,共3页Chinese Journal of Geriatrics

基　　金：北京市保健科研课题项目（京11-04）

摘　　要：目的探讨老年患者慢性肾脏病（cKD）分期中评价肾功能的。肾小球滤过率（GFR）分界值45ml·min-1·1．73m^-2的意义。方法选择我院就诊患者2258例，根据年龄分为非老年组和老年组，采用注射99^m锝（Tc）标记二乙三胺五醋酸（DTPA）肾动态显像方法测定GFR并进行CKD分期，采集血标本检测血清肌酐（SCr）、血红蛋白和红细胞压积。结果2组患者血清肌酐、GFR、血红蛋白和红细胞压积及CKD各期构成比比较差异有统计学意义（P〈0．05），老年组血清肌酐高于非老年组（Z=-11．15，P〈0．01），GFR、血红蛋白和红细胞压积均低于非老年组（F=1．60、Z=-14．63、Z=-12．60，均P〈0．01），CKD各期构成比均大于非老年组（X^2=276．40，P〈0．01）。2组患者血红蛋白均值和贫血发生率在不同CKD分期比较，差异有统计学意义（X^2值分别为=97．03、204．80、268．38、340．00，均P％0．05）。CKD各期间两两比较，非老年组血红蛋白均值和贫血发生率在CKD3a期和3b期间比较差异无统计学意义（Z=-0．94、X^2=0．43、均P〉0．05）；老年组血红蛋白均值和贫血发生率CKD3a期和3b期比较，CKD3a期血红蛋白均值高，贫血发生率低（Z=-5．20、X^2=18．39，均P％0．01）。结论老年患者中，GFR〉60ml·min^-1·1．73m^-2比例增高，GFR分界值45ml·min·1．73m^-2的提出对于评估老年人群慢性肾脏病具有现实意义。Objective To explore the clinical value of glomerular filtration rate （ GFR ） 45 ml · min^-1 1.73 m-2 for the stage assessment in the elderly patients with chronic kidney disease （CKD）. Methods From June 2009 to December 2011, 2258 patients were recruited and divided into the non elderly group （n=989） and the elderly group （n=1269） according to age. GFR was assessed and classified by 99mTc- DTPA renal dynamic imaging method and calculated using the modified Gate＇s method. The levels of serum creatinine （SCr）, haemoglobin （Hb） and hematoerit （HCT） were measured simultaneously. Results The SCr level was higher in elderly group than in non-elderly group （Z =-11.15,P〈0.01）. The levels of GFR, Hb and HCT were lower in elderly group than in non- elderly group （F= 1. 60, Z=- 14. 63, Z= - 12. 60, respectively, all P%0. 01）. The constituent ratios in different CKD stages were increased in elderly group compared with non- elderly group （Z2= 276. 40, P〈0. 01）. There were statistical differences in Hb concentration and anemia incidence between the two groups at different CKD stages （X^2 = 97. 03, 204. 80, 268. 38, 340. 00, respectively, all P〈0.05）. In non-elderly group, the Hb concentration and anemia incidence had no significant differences between in the stages of CKD3a and in CKD3b （Z= -10. 94, X^2 = 0. 43, all P〈0.05）. In elderly group, Hb concentration was higher and anemia incidence was lower in CKD3a than in CKD3b （Z= - 15. 20, X2 = 18. 39, P〈 0. 01）. Conclusions The ratio of patients with GFR 〉60 ml · min -1 . 1.73 m-2 is increased in the elderly. It has a practical value to propose the boundary value of GFR 45 ml · min -1· 1.73 m -2 for the assessment in elderly people with CKD.

关 键 词：慢性肾脏病 肾小球滤过率 贫血 

分 类 号：R692[医药卫生—泌尿科学]