肾小球滤过率的测定方法及其临床应用  

The methods for measuring glomerular filtration rate and their clinical application

作　　者：虞倩[1] 王蓓丽[1] 郭玮[1] 潘柏申[1] 

机构地区：[1]复旦大学附属中山医院检验科,上海200032

出　　处：《检验医学》2015年第7期674-679,共6页Laboratory Medicine

基　　金："十二五"国家科技支撑计划资助项目(2012BAI37B01);国家临床重点检验专科建设项目资助

摘　　要：肾小球滤过率(GFR)是衡量肾功能的最佳指标,在临床工作中具有重要的参考价值,其数值是否准确对诊疗决策的优化影响重大。GFR可以通过估算公式或直接测量获得,估算肾小球滤过率(eGFR)在特定情况或特殊人群中易出现偏倚,采用直接测量的GFR(mGFR)评价肾功能更为准确。结合菊粉、肌酐、碘海醇、99m锝-二乙烯三胺五醋酸(99mTc-DTPA)、51铬-乙二胺四乙酸、125I-碘肽酸盐等常用肾小球滤过标志物的不同特性,可分别采用血、尿清除率或肾动态显像法测量mGFR,但所得结果的准确性不一。鉴于其它方法的耗时繁琐,临床应用多选择内生肌酐清除率(Ccr)对肾功能进行评估,但综合各项研究证实Ccr存在显著偏倚,易高估GFR。尿液碘海醇清除率、99mTc-DTPA清除率的准确性较高,更适宜推广于临床。GFR测量方法作为各类eGFR公式的验证手段,在临床工作中的应用和评价不容忽视,值得进一步研究。As the best scaleplate for evaluation on kidney function,the glomerular filtration rate（ GFR） plays an important role in daily practice and has a great influence on the optimization of diagnosis and treatment. GFR can be estimated through different formulas based on routine text results or measured directly. Bias may arise in certain situations as well as special populations when using estimated glomerular filtration rate（ eGFR）,while measured glomerular filtration rate（ mGFR） is more reliable. Regarding the different properties of common filtration markers such as inulin,creatinine,iohexol,99mtechnetium-diethylene triamine pentaacetic acid（99mTc-DTPA）,51chromium-ethylene diamine tetraacetic acid and iothalamate,we could measure mGFR by means of blood and urine clearance rates or kidney dynamic imaging,and the results shows different accuracies. Endogenous creatinine clearance rate is widely used in common practice for convenience,while plenty of studies have revealed its remarkable bias of overestimating GFR.Regarding the outstanding performances in accuracy,either urine iohexol or99mTc-DTPA clearance rate is better for popularization. As the validation for eGFR,mGFR deserves further work on its application and evaluation.

关 键 词：肾小球滤过率 内生肌酐清除率 碘海醇 放射性核素 肾功能 

分 类 号：R446.1[医药卫生—诊断学]