肌酐全年龄阶段新公式在慢性肾脏病患者中的临床应用研究  

Clinical application of full age spectrum formula based on serum creatinine in patients with chronic kidney disease

作　　者：黄思华 吴锡信 Huang Sihua;Wu Xixin(Guangdong Medical University,Zhanjiang 524023,Guangdong,China;Department of Nephrology,Guangdong Provincial Second People＇s Hospital,Guangzhou 510317,Guangdong,China)

机构地区：[1]广东医科大学,广东湛江524023 [2]广东省第二人民医院肾内科,广东广州510317

出　　处：《中华危重病急救医学》2018年第9期877-881,共5页Chinese Critical Care Medicine

基　　金：广东省佛山市医学科技计划项目（2015AB000642）

摘　　要：目的比较5种肌酐公式估算的肾小球滤过率（eGFR），探讨肌酐全年龄阶段（FAS）公式对慢性肾脏病（CKD）患者肾功能不全的诊断效能。 方法选择2015年12月至2018年1月就诊于广东省第二人民医院肾内科的2？219例CKD患者，根据美国肾脏患者生存质量提倡指南（/OQI）的诊断标准分为CKD 1~5期。所有患者于1个月内以99m锝-二亚乙基三胺五乙酸（99m？Tc-DTPA）清除率评估肾小球滤过率（Tc-GFR），同时检测血肌酐（SCr）。分别采用基于SCr的Cockcroft-Gault（C-G）公式、中国改良简化肾脏病膳食改良试验（cMDRD）公式、慢性肾脏病流行病学协作组（CKD-EPI）公式、吴氏测算（MC）公式、FAS公式计算eGFR，并经体表面积校正。比较各种公式计算的eGFR与Tc-GFR的差异；采用Spearman相关分析评估各种公式eGFR与Tc-GFR的相关性。以Tc-GFR为参考标准，评价各种公式的偏倚、精确性和准确性；绘制各种公式eGFR的受试者工作特征曲线（ROC），评估其对CKD患者肾功能不全的诊断效能。结果根据纳入、排除标准筛选患者后，共382例CKD患者纳入最终分析，CKD 1~5期患者分别为31、69、92、75、115例。在全体患者中，各种公式的eGFR与Tc-GFR差异均有统计学意义，且eGFR与Tc-GFR均呈显著正相关，以cMDRD公式eGFR与Tc-GFR的相关性最好（r=0.883，P=0.000），MC公式的相关性最差（r=0.848，P=0.000）；FAS公式eGFR在CKD 2期患者中与Tc-GFR的相关性最好（r=0.538，P=0.000），在CKD 5期患者中的相关性最差（r=0.229，P=0.014）。以Tc-GFR为参考标准，FAS公式偏倚最小〔Tc-GFR与eGFR差值=8.64，95%可信区间（95%CI）=7.04~10.19〕，准确性最佳〔eGFR落入Tc-GFR 30%范围内的百分比（P30）=42.67%，95%CI=37.69~47.65〕；CKD-EPI公式精确性最好（Tc-GFR与eGFR差值的QR=17.43，95%CI=15.33~21.28）。ROC曲线分析显示，cMDRD公式的ROC曲线下面积（AUC）最大（0.944）ObjectiveTo compare the estimated glomerular filtration rates （eGFR） by five formulas based on serum creatinine （SCr）, and to explore the diagnostic efficacy of full age spectrum （FAS） equation based on SCr for renal insufficiency in patients with chronic kidney disease （CKD）. Methods2？219 patients with CKD admitted to department of nephrology of Guangdong Provincial Second People＇s Hospital from December 2015 to January 2018 were enrolled. According to the diagnostic criteria of kidney disease outcomes quality initiative （/OQI）, patients were divided into CKD 1-5 stages. In all patients, Tc-GFR was measured by clearance rate of 99m？Tc-diethylene triaminepen taacetic acid （99m？Tc-DTPA） within 1 month, and SCr was determined. The eGFR was calculated by Cockcrofi-Gault （C-G） formula bases on SCr, Chinese modified modification of diet in renal disease （cMDRD） equation, Chronic Kidney Disease Epidemiology Collaboration Group （CKD-EPI） equation, measure and calculation （MC） equation and FAS equation, respectively, and body surface area （BSA） was used for correction of eGFR. The differences of Tc-GFR and eGFR calculated by different formulas were compared, and the correlations between eGFR calculated by different formulas and Tc-GFR were analyzed by Spearman correlation analysis. Tc-GFR was used as a reference standard to evaluate the bias, precision and accuracy of eGFR formulas, and the receiver operating characteristics （ROC） curve of each eGFR formula was plotted to evaluate its diagnostic efficacy for renal insufficiency in patients with CKD. ResultsAccording to the inclusion and exclusion criteria, 382 patients with CKD were enrolled in the final analysis. There were 31, 69, 92, 75 and 115 patients with CKD 1-5 stages, respectively. In all patients, the differences between Tc-GFR and eGFR calculated by different formulas were statistically significant, and eGFR was positively correlated with Tc-GFR. The best correlation coefficient was between eGFR of

关 键 词：肾小球滤过率 慢性肾脏病 肌酐 公式 

分 类 号：R692[医药卫生—泌尿科学]