应用碘海醇血浆清除率检测肾小球滤过率的方法选择与评估  

Measurements of glomerular filtration rate with iohexol plasma clearance: method selection and evaluation

作　　者：史浩[1] 姜梦迪 谢静远[1] 沈平雁[1] 李晓[1] 张文[1] Shi Hao;Jiang Mengdi;Xie Jingyuan;Shen Pingyan;Li Xiao;Zhang Wen(Department of Nephrology,Ruijin Hospital, Institute of Nephrology, Shanghai Jiao Tong UniversitySchool of Medicine, Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院肾脏科,上海200025

出　　处：《中华肾脏病杂志》2019年第4期281-287,共7页Chinese Journal of Nephrology

基　　金：上海市科学技术委员会医学引导课题(15411963800).

摘　　要：目的在慢性肾脏病(CKD)人群中,比较碘海醇(iohexol)血浆清除率(Iohexol-GFR)三点法(I-GFR-TS)、两点法(I-GFR-DS)、单点法(I-GFR-SS)的一致性,选择最优化肾小球滤过率(GFR)的检测方案。方法选择2017年8月至2018年7月在上海瑞金医院肾脏科住院的174例CKD患者,静脉注射碘海醇5 ml后,根据估算GFR(eGFR)分组,在不同时间点留取血浆样本3次,首次取血点为2 h,末次取血点随eGFR降低相应由4 h延迟至6 h,同位素Gates法作为同步对照检测GFR。以I-GFR-TS为标准,比较了I-GFR-DS、I-GFR-SS和同位素Gates法检测GFR的准确性。结果与I-GFR-TS法相比,I-GFR-DS、I-GFR-SS、Gates法在总体人群的中位偏差分别为-0.15、-1.00、6.76 ml·min^-1·(1.73 m^2)^-1,P10(与标准I-GFR-TS相比,检测值偏离在10%内的比例)分别为95.4%、74.1%、28.7%,P30分别为100.0%、93.7%、72.4%;在eGFR<30 ml·min^-1·(1.73 m^2)^-1组,I-GFR-SS取血时间由4 h延至6 h,提高了准确度[P10:43.5%比17.4%,P=0.055;P30:73.9%比43.5%,P<0.05]。结论临床建议选择Iohexol-GFR两点法,单点法准确性稍差但更便捷,可作为次选方案,取血时间应据eGFR调整(尤其中重度肾损伤患者);同位素Gates法不宜用于常规GFR检测。Objective To compare the consistency between single-(I-GFR-SS) and dual-(I-GFR-DS) sample methods with three-sample method (I-GFR-TS) of iohexol plasma clearance in chronic kidney disease (CKD) patients for choosing the optimizing project of glomerular filtration rate (GFR) measurement. Methods The multiple-sample methods were performed in 174 patients with CKD admitted to the Department of Nephrology, Shanghai Ruijin Hospital from August 2017 to July 2018. Plasma concentrations of iohexol were measured three times at different time points after receiving 5 ml iohexol (300 g/L) intravenous injection, according to estimated GFR (eGFR) grouping. The first blood sample was collected at 2 hours, and the time for the last sample was delayed from 4 hours to 6 hours with reduction of eGFR. The synchronized Gates (99mTc-Gates-GFR) method was detected as control. With I-GFR-TS as the golden standard, the accuracies of I-GFR-DS, I-GFR-SS and 99mTc-Gates-GFR were compared. Results The median differences of I-GFR-DS, I-GFR-SS and 99mTc-Gates-GFR in overall patients were -0.15,-1.00, 6.76 ml·min^-1·(1.73 m^2)^-1 comparing with I-GFR-TS;P10(percentage of the GFR measurements that was within 10% of the standard method) were 95.4%, 74.1%, 28.7%, and P30 were 100%, 93.7%, 72.4% separately. In the patients with eGFR<30 ml·min^-1·(1.73 m^2)^-1, I-GFR-SS was more accurate when last point collecting extended to 6 h from 4 h [P10: 43.5% vs 17.4%, P=0.055;P30: 73.9% vs 43.5%, P<0.05]. Conclusions The dual-sample plasma clearance of iohexol is recommended in clinical practice, and the single-sample method can be a secondary option because of its slightly poor accuracy but more convenient. Sample-collection protocol should be adjusted according to eGFR especially in moderate-to-severe CKD patients. The Gates method is not recommended.

关 键 词：肾小球滤过率 碘海醇 肾功能不全 慢性 单点法 多点法 

分 类 号：R692[医药卫生—泌尿科学]