肾小球滤过率评估方程在糖尿病患者中的应用  

Application of estimation equations for glomerular filtration rate intype 2 diabetes mellitus

作　　者：李飞[1] 邓庆梅[2] 黄山[1] 张罡[1] 张敬苗[1] 

机构地区：[1]安徽医科大学第二附属医院核医学科,安徽合肥230601 [2]中国科学院合肥肿瘤医院检验科,安徽合肥230031

出　　处：《中国医学影像技术》2017年第8期1246-1251,共6页Chinese Journal of Medical Imaging Technology

摘　　要：目的评估美国慢性肾脏病流行病学协作组(CKD-EPI)系列方程及修正方程预测糖尿病患者肾小球滤过率(GFR)的效能,包括CKD-EPI肌酐(Scr)方程(CKD-EPI_(scr))、CKD-EPI半胱氨酸蛋白酶抑制剂C(SCysC)方程(CKD-EPI_(scysc))、CKD-EPI Scr和SCysC混合方程(CKD-EPI_(Scr-SCysC))、亚洲CKD-EPI方程(CKD-EPI_(亚洲))、中国糖尿病CKD-EPI方程(CKD-EPI_(糖尿病))及改良肾脏病膳食改良实验(MDRD)、Cockcroft-Gault(CG)方程、简化MDRD方程。方法采用碱性苦味酸法测定血清Scr,胶乳增强免疫透射比浊法测定血清ScysC,^(99)Tc-DTPA肾动态显像法测定GFR,并经体表面积标准化后获得rGFR。分析Scr、ScysC、各方程计算获得GFR(eGFR)与rGFR的相关性,并比较各方程的30%符合率、各方程eGFR与rGFR的偏差和偏离程度及一致性。以rGFR<60ml/(min·1.73m^2)为诊断肾功能不全的标准,采用ROC曲线分析各公式eGFR诊断肾功能不全的效能。结果 Scr、Scys与rGFR呈负相关(P均<0.001);各方程CKD-EPIScr、CKD-EPIScysC、CKD-EPI_(Scr-SCysC)、CKD-EPI_(亚洲)、CKD-EPI_(糖尿病)、改良MDRD、CG、简化MDRD测量的eGFR与rGFR均呈正相关(P均<0.001)。CKD-EPI_(糖尿病)、简化MDRD测量的eGFR与rGFR30%符合率较高;CKD-EPIScr、CKD-EPI_(亚洲)、CKDEPI_(糖尿病)、改良MDRD测得的eGFR与rGFR差异无统计学意义(P均>0.05);CKD-EPI_(糖尿病)测量的eGFR与rGFR一致性最好,其余所有公式一致性均超过预定的界限。ROC曲线示CKD-EPI_(糖尿病)测量的eGFR曲线下面积最大、Youden指数最高。结论 8种公式预测的eGFR均存在不同程度偏差,中国2型糖尿病方程CKD-EPI准确率和一致性最佳。Objective To investigate the application value of chronic kidney disease epidemiology collaboration（CKDEPI）equations and amendatory equations for calculating glomerular filtration rate（GFR）in Chinese patients with diabetes,including CKD-EPI serum creatinine（Scr）equation（CKD-EPI（scr））,CKD-EPI serum cystatin C（ScysC）equation（CKDEPI（scysc））,combination of CKD-EPI（scr）and CKD-EPI（Scr-SCysC）（CKD-EPI（Scr-SCysC））,Asian modified CKD-EPI equation（CKDEPI（Asian））,Chinese diabetes CKD-EPI equation（CKD-EPI（Diabetes））,refitted modification of diet in renal disease（MDRD）equation（rMDRD）,Cockcroft-Gault equation（CG）and Simplified MDRD equation.Methods Serum creatinine（Scr）was detected using basic picric acid method,serum cystatin C（CysC）was measured by Latex enhanced turbidimetric,and the reference value of GFR was worked out by 99Tc^m-DTPA renal dynamic imaging and standardization of body surface area.Relation of Scr,Scysc,GFR measured by every equations and rGFR were analyzed.The accuracy of 30% of each equation,the consistency and deviation of the evaluation of renal function by each equation were compared.The diagnostic efficacy in GFR60 ml/（min · 1.73m2）was compared using the receiver operating characteristic（ROC）curve.Results The rGFR had negative correlation with Scr、ScysC（both P0.001）.The rGFR had positive correlation with GFR measured by CKD-EPIScr,CKD-EPIScysC,CKD-EPI（Scr-SCysC）,CKD-EPI（Asian）,CKD-EPI（Diabetes）,rMDRD,CG and Simplified MDRD（all P0.001）.The coincidence rate between 30% of rGFR and GFR measured by CKD-EPI（Diabetes）and simplified MDRD were higher.There was no significant difference of rGFR and GFR measured by CKD-EPIScr,CKD-EPIScysC,CKD-EPI（Scr-SCysC）,CKDEPI（Asian）,CKD-EPI（Diabetes）,rMDRD,CG and Simplified MDRD.GFR measured by CKD-EPI（Diabetes）has the best consistent degree with rGFR.ROC curve showed that the area under curve of GFR measured by CKD-EPI（Diabetes） was larg

关 键 词：糖尿病 2型 肾小球滤过率 肾小球滤过率评估方程 

分 类 号：R587.2[医药卫生—内分泌] R817.4[医药卫生—内科学]