肾小球滤过率评估方程在慢性肾脏病儿童中的适用性评价  

Appliealibity of various estimation formulas to evaluate renal glomerular filtration rate in children with chronic kidney disease

作　　者：侯玲[1] 李雨生 程俊丽[1] 李姗萍 孙婷婷[1] 杜悦[1] Hou Ling;Li Yusheng;Cheng Junli;Li Shanping;Sun Tingting;Du Yue(Pediatric Nephrology Department, Sheng]ing Hospital of China Medical University, Shenyang 110004, China)

机构地区：[1]中国医科大学附属盛京医院小儿肾脏风湿免疫科,沈阳110004

出　　处：《中国小儿急救医学》2018年第3期196-202,207,共8页Chinese Pediatric Emergency Medicine

基　　金：辽宁省自然科学基金计划项目（2015020492）

摘　　要：目的旨在比较基于血肌酐及血清胱抑素C（Cys C）的公式评估儿童慢性肾脏病（chronic kidney disease，CKD）患儿肾小球滤过率（renal glomerular filtration rate，GFR）的准确性及适用性。方法收集2011年1月至2016年10月于中国医科大学附属盛京医院小儿肾脏科住院的CKD患儿。应用11种评估公式计算肾小球滤过率评估值（eGFR），同时采用99mTc-DTPA肾动态显像（Gates法）作为金标准计算标准肾小球滤过率（sGFR）。应用SPSS 22.0统计软件比较各公式的准确性及血β2微球蛋白（β2-MG）及Cys C与sGFR的相关性。结果共纳入609例患儿，其中CKD 1期332例（男211例，女121例），CKD 2期165例（男99例，女66例），CKD 3期70例（男43例，女27例），CKD 4期22例（男13例，女9例），CKD 5期20例（男16例，女4例）。这11种评估公式均存在过高或过低估计sGFR，相对而言，CKD-EPI公式及Filler公式在中国儿童CKD评估中准确性较高。血β2-MG及Cys C与sGFR呈负相关（Pearson相关系数分别为r＝－0.478和r＝－0.585，P〈0.01）。结论血β2-MG及Cys C均可反映肾功能，CKD-EPI公式及Filler公式较其他公式更适用于评估中国CKD儿童肾功能，但仍存在过高或过低估计sGFR。收集大样本，开发适宜我国儿童的GFR评估公式仍是目前亟需完成的任务。ObjectiveThis study was to evaluate the relative applicability of serum cystatin C（Cys C）-based formulas and serum creatinine-based formulas for renal glomerular filtration rate（GFR）of Chinese children with chronic kidney disease（CKD）.MethodsSix hundred and nine Chinese CKD patients of less than 18 years old were enrolled from January 2011 to October 2016 in Shengjing Hospital of China Medical University.The value for estimated GFR（eGFR）was derived from using the 11 formulas,and 99mTc-DTPA renal dynamic imaging was the golden standard of standard GFR（sGFR）.SPSS 22.0 statistical software was used to compare the accuracy of each assessment formula and the correlation between GFR markers（Cys C,β2-MG）and sGFR.ResultsA total of 609 children were enrolled,including 332 patients in CKD stage 1（211 males and 121 females）,165 patients in CKD stage 2（99 males and 66 females）,70 patients in CKD stage 3（43 males and 27 females）,22 patients in CKD stage 4（13 males and 9 females）,and 20 patients in CKD stage 5（16 males and 4 females）.All of the formulas either overestimate or underestimate GFR in children with CKD.In contrast with other formulas,CKD-EPI formula and Filler formula performed better regardless of gender and age difference.Serum β2-MG and serum Cys C all showed a negative relationship with sGFR（respectively r=-0.478 and r=-0.585,P〈0.01）.ConclusionCKD-EPI formula and Filler formula provide the better approximation to sGFR than other formulas in Chinese children with CKD.However,we need to try our best to enroll more patients to develop a more accurate GFR estimation formula in Chinese children.

关 键 词：慢性肾脏病 肾小球滤过率 胱抑素C 血清肌酐 

分 类 号：R726.9[医药卫生—儿科]