核素肾动态显像评估12种肾小球滤过率计算公式在肾脏疾病中应用  

Evaluation of 12 glomerular rate filtration formulas by radionuclide renal dynamic imaging in kidney diseases

作　　者：李飞[1] 邓庆梅 黄山[1] 王为民 张罡[1] 张敬苗[1] 朱夏夏 庞小溪 LI Fei;DENG Qing-mei;HUANG Shan;WANG Wei-min;ZHANG Gang;ZHANG Jing-miao;ZHU Xia-xia;PANG Xiao-xi(Department of Nuclear Medicine,the Second Hospital of Anhui Medicine University,Hefei 230601,Anhui,China;Department of Laboratory,Hefei Cancer Hospital,Chinese Academy of Sciences,Hefei 230031,Anhui,China;Department of Medical Oncology,Hefei Cancer Hospital,Chinese Academy of Sciences,Hefei 230031,Anhui,China)

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 [3]中国科学院合肥肿瘤医院肿瘤内科,安徽合肥230031

出　　处：《生物医学工程与临床》2021年第2期170-178,共9页Biomedical Engineering and Clinical Medicine

基　　金：江苏省放射医学与防护重点实验室开放课题(KJS2001);安徽医科大学第二附属医院临床研究培育计划(2020LCZD14)。

摘　　要：目的核素肾动态显像评估12种肾小球滤过率(GFR)计算公式在估算肾脏疾病患者GFR中适用性。方法选择肾脏疾病患者137例,其中男性84例,女性53例;年龄16~85岁,中位年龄52.5岁;慢性肾脏病(CKD)84例,非CKD 53例。行99m锝-二乙三胺五乙酸(99mTc-DTPA)肾动态单光子发射体层摄影术(SPECT)测定GFR。以SPECT所测得的GFR(i GFR)作为参考标准,以临床应用的12种方程(如MDRD公式、CKD-EPI、CG公式、Hojs公式、Filler公式)估算GFR(e GFR)为对照,分析各e GFR与i GFR的相关性、偏差、精确度、准确率、一致性及各公式预测早期CKD[或肾功能下降i GFR<60 m L/(min·1.73 m^(2))]诊断效能。结果各e GFR与i GFR均显示相关性(P<0.05)。在数值估算上,CKD组中CKD-EPI糖尿病估算的e GFR与i GFR有较小偏差、较高精确度、较高符合率及一致性,非CKD组一致性超过预定的界限。12种公式预测早期CKD[或肾功能下降i GFR<60 m L/(min·1.73 m^(2))]诊断效能受试者工作特性(ROC)曲线下面积示CKD-EPI糖尿病测量的e GFR曲线下面积、Youden指数最大,非CKD组Hojs公式、Filler公式测量的e GFR曲线下面积、Youden指数最大。结论12种公式预测的e GFR均存在不同程度偏差,CKD-EPI糖尿病在CKD、非CKD两组中预测GFR值最适用;CKD-EPI糖尿病预测CKD组早期CKD发生诊断效能最大,Hojs公式、Filler公式预测非CKD组早期肾功能下降[GFR<60 m L/(min·1.73 m^(2))]发生诊断效能最大。Objective To evaluate the applicability of 12 calculation formulas for glomerular filtration rate(GFR)in estimating GFR of nephropathy patients by radionuclide renal dynamic imaging.Methods A total of 137 patients with nephropathy were enrolled,which included 84 males and 53 females,aged 16-85 years old with median age of 52.5 years old,chronic kidney disease(CKD)in 84 cases and non-CKD in 53 cases.The GFR was measured by99 mTc-diethylenetriamine pentaacetic acid(99 mTc-DTPA)renal dynamic single photon emission computed tomography(SPECT).The SPECT obtained GFR(i GFR)were used as reference standard,and estimated GFR(e GFR)by 12 kinds of clinically applied formulas(such as MDRD formula,CKD-EPI,CG formula,Hojs formula,Filler formula)were regarded as control.The correlation,deviation,precision,accuracy,consistency between e GFR and i GFR,and diagnostic efficacy of each formula in predicting early CKD[or renal function decline i GFR<60 m L/(min·1.73 m^(2))]were analyzed.Results All e GFR showed correlation(P<0.05)with i GFR.In numerical estimation,the e GFR and i GFR estimated by CKD-EPIdiabetesin CKD group showed smaller deviation,higher precision,coincidence rate and consistency,while the consistency of non-CKD group exceeded predetermined limit.Twelve formulas predicted early CKD[or renal function decline i GFR<60 m L/(min·1.73 m^(2))]diagnostic efficacy area under receiver operating characteristic(ROC)curve,CKD-EPIdiabetesmeasured area under e GFR curve and Youden index was the largest,and Hojs formula and Filler formula measured area under e GFR curve and Youden index in non-CKD group was the largest.Conclusion It is demonstrated that the e GFR predicted by 12 formulas showed different deviation,CKD-EPIdiabetesis the most suitable for predicting GFR in CKD and non-CKD groups.The CKD-EPIdiabetesshowed the highest diagnostic efficiency in predicting early CKD in CKD group,the Hojs formula and Filler formula showed the highest diagnostic efficiency in predicting early renal function decline in non-CKD group[GFR<60

关 键 词：肾动态显像 单光子发射体层摄影术(SPECT) 慢性肾脏病 肾小球滤过率 肾小球滤过率评估方程 

分 类 号：R817.4[医药卫生—影像医学与核医学] R692[医药卫生—放射医学]