肾小球滤过率评估方程在中国糖尿病合并慢性肾脏病患者中的适用性评价  

Applicability evaluation of the GFR equations in Chinese patients with diabetes mellitus complicated with CKD

作　　者：吕潇阳 钟良宝[1] 王善志 朱永俊[1] 李晓燕 LV Xiao-yang;ZHONG Liang-bao;WANG Shan-zhi;ZHU Yong-jun;LI xiao-yan(Department of Nephrology,The First Affiliated Hospital of Hainan Medical University,Haikou 570102,China)

机构地区：[1]海南医学院第一附属医院肾内科

出　　处：《临床肾脏病杂志》2019年第10期719-726,733,共9页Journal Of Clinical Nephrology

基　　金：国家自然科学基金(81660131)

摘　　要：目的探讨临床上使用广泛的慢性肾脏病流行病学协助组(CKD-EPI)肾小球滤过率(GFR)评估方程、改良肾脏病膳食改良试验(MDRD)方程与近年来针对中国人开发的Feng方程、针对中国糖尿病患者改良的CKD-EPI糖尿病方程在中国糖尿病合并慢性肾脏病(CKD)患者中的适用性,进而为临床中准确估测糖尿病合并CKD患者GFR提供更精确的依据。方法选取2型糖尿病合并CKD患者160名。收集患者性别、年龄、身高、体质量、血肌酐(Scr)及胱抑素C(Cys C)。以99m Tc-DTPA肾动态显像法测定的GFR作为参考GFR(rGFR)。使用中国改良MDRD方程、CKD-EPI Scr方程、CKD-EPI Cys C方程、CKD-EPI Scr-Cys C方程、CKD-EPI糖尿病方程、Feng Cys C方程及Feng Scr-Cys C方程对估算GFR(eGFR)进行计算。采用Pearson相关性分析及κ检验比较各方程eGFR与rGFR之间的相关性及分期一致性,并使用Bland-Altman分析法比较各方程eGFR与rGFR的一致性限度。各方程eGFR之间的比较使用偏倚、精确度、10%准确率、30%准确率、50%准确率。定义GFR<60 mL min^-1 (1.73 m^2)^-1为肾功能不全的诊断标准,通过ROC曲线比较各方程诊断肾功能不全的效能。根据rGFR将患者分为A组(CKD 4~5期)、B组(CKD 3期)、C组(CKD 1~2期),比较不同分组中各方程的适用性。结果在各方程eGFR之间的比较中,CKD-EPI糖尿病方程偏倚最小,与Feng Cys C方程、Feng Scr-Cys C方程比较差异有统计学意义(P<0.05);精确度最高,与改良MDRD方程、CKD-EPI Cys C方程比较差异有统计学意义(P<0.05)。在7种方程的准确率比较中,CKD-EPI糖尿病方程10%、30%准确率均最高,与简化MDRD方程、CKD-EPI Scr方程、CKD-EPI Cys C方程比较差异均有统计学意义(P<0.05)。Bland-Altman分析显示CKD-EPI糖尿病方程一致性限度最佳。在A组患者中,CKD-EPI Cys C方程eGFR与rGFR均值比较差异无统计学意义,偏倚最小,50%、30%准确率最高。B组患者与总体患者类似,CKD-EPI糖尿病方�Objective To explore applicability of Chronic Kidney Disease Epidemiology Collaboration(CKD-EPI)’s glomerular filtration rate(GFR)equations,including modified modification of diet in renal diseases(MDRD)equation,the Feng equation developed for Chinese in recent years,and modified CKD-EPI diabetes equation for Chinese patients with diabetes,in Chinese patients with diabetes mellitus complicated with CKD;furthermore,to provide a more accurate basis for accurate estimation of GFR in patients with diabetes complicated with CKD.Methods A total of 160 patients with type 2 diabetes with CKD were selected.The patient's data on gender,age,height,weight,blood creatinine(Scr)and cysteine protease inhibitor C(Cys C)were collected.GFR determined by 99m Tc-DTPA renal dynamic imaging was used as a reference standard(rGFR).Modified equations for Chinese patients,including MDRD equation,CKD-EPI Scr equation,CKD-EPI Cys C equation,CKD-EPI Scr-Cys C equation,CKD-EPI diabetes equation,Feng Cys C equation and Feng Scr-Cys C equation,were used to estimate GFR(eGFR).Pearson correlation analysis and Kappa test were used to compare the correlation and staged consistency between eGFR and rGFR for each equation.Bland-Altman analysis was used to compare the consistency limits of eGFR and rGFR for each equation.Bias,precision,10%accuracy,30%accuracy and 50%accuracy were used to compare eGFR values for each equation.GFR<60 mL min^-1 (1.73 m^2)^-1 was defined as the diagnostic criteria for renal insufficiency,and the performances of various equations for diagnosing renal insufficiency were compared by ROC curve.Patients were divided into group A(CKD stage 4~5),group B(CKD stage 3),and group C(CKD stage 1~2)according to the rGFR,and the applicability of various equations in each group was compared.Results In the comparison of eGFR between the equations,the CKD-EPI diabetes equation had the smallest bias,with differences of statistical significance compared to Feng Cys C equation and Feng Scr-Cys C equation(P<0.05);it had the highest precision

关 键 词：肾小球滤过率评估方程 糖尿病 慢性肾脏病 糖尿病肾脏病 

分 类 号：R69[医药卫生—泌尿科学]