高龄慢性肾脏病患者肾小球滤过率评估公式比较  

Comparison of the glomerular filtration equation in very elderly patients with chronic kidney disease in China

作　　者：张艳[1] 傅辰生[1] 王姣锋[1] 冯欣慧[1] 张晓丽[1] 张振兴[1] 肖婧[1] 叶志斌[1] 

机构地区：[1]复旦大学附属华东医院肾内科,上海市200040

出　　处：《老年医学与保健》2014年第4期259-262,共4页Geriatrics & Health Care

摘　　要：目的 评价常用的肾小球滤过率评估公式在高龄慢性肾脏病CKD患者中的适用性.方法 选择高龄CKD患者217例,采用CG公式、校正CG公式、简化MDRD公式、改良简化MDRD公式（rMDRD公式）、针对中国CKD患者的改良简化MDRD公式（cMDRD公式）、CKD-EPI公式分别估测GFR,与BSA标准化的以Gates法^99mTc-DPTA法测定的GFR（mGFR）进行比较.采用偏差、准确率、MSPR、线性相关及直线回归分析、Bland-Altman曲线分析等方法评估各公式的优劣.并探索使用数据转换的方式进一步对估测公式的应用价值进行评估.结果 CKD-EPI公式较其他公式具有较小的偏差（估测偏差绝对值百分数=26.57 mL·min^-1·1.73 m^-2,P=0.048）、更优的准确性（15％准确率=31.8％,P＜0.001;30％准确率=56.68％,P=0.043）和更强的相关性（r=0.756,P＜0.001）,然而各公式30％准确率均低于60％,Bland-Altman曲线分析显示校正CG公式一致性较好（＜60 mL·min^-1· 1.73 m^-2）,其余公式一致性均欠佳.经数据转换,可改善各公式的准确性.结论 当血肌酐的测定方法为酶法时,以临床常用的GFR评估公式预测高龄CKD患者的GFR,可能产生明显偏差.从本研究提示,CKD-EPI公式表现优于其他公式,可能更适合我国高龄CKD患者.Objective To evaluate the applicability of glomerular filtration equation in very elderly patients with chronic kidney disease （CKD） in China. Methods Based on measured glomerular filtration rate / mGFR ） obtained with the ^99mTC diethylene triamine pentaacetic acid （^99mTc-DTPA） renal dynamic imaging method and standardized by body surface area （BSA）, 217 very elderly Chinese CKD patients were enrolled in this study. The GFR was estimated using the CG equation, calibrated CG equation, simplified MDRD equation （aMDRD）, re-expressed MDRD equation （rMDRD equation）, modified MDRD equation for Chinese CKD patients （cMDRD equation） and Chronic kidney disease epidemiology collaboration （CKD-EPI） equation. Performance inbias, accuracy, mean squaredpredicationresidual （MSPR）, linear correlation, linear regression analysis and Bland-Altman plot analysis of these equations were assessed. Data conversion was used to further evaluate the application value of these equations. Results When comparing the bias and accuracy of estimated GFR （eGFR） with mGFR, eGFR estimated by CKD-EPI equation showed better results. The median absolute percentage difference of CKD-EPI was 26.57 mL·min^-1·1.73 m^-2 （P=0.048）. The 15% accuracy was 31.8% （P〈0.001）, and 30% accuracy was 56.68 % （P=0.043）. The correlation analysis revealed eGFR of CKD-EPI equation was strongly correlated with mGFR （r=0.756, P〈0.001）. The 30% accuracy of all the equations lower than 60% level. But the agreement limits of the equations, except for the calibrated CG equation, exceeded the prior acceptable tolerances, defined as 60 mL·min^-1· 1.73 m^-2. Data conversion might improve the performance. Conclusions When plasma creatinine is checked by enzymatic method, none of these equations were suitable for estimating GFR in the very elderly Chinese population investigated. At present, based on overall performance, the CKD-EPI equation may be the most accurate for estimating GFR in very elderly Chinese patients w

关 键 词：高龄 慢性肾脏病 肾小球滤过率 

分 类 号：R575[医药卫生—消化系统]