肾小球滤过率估算公式在60岁以上老年慢性肾脏病患者中的应用  

Application of glomerular filtration rate estimation equations in elderly patients with chronic kidney disease over 60 years old

作　　者：孙颖[1] 陈爱群[1] 李文婵[2] 姚稚明[2] 杨继红[1] Sun Ying;Chen Aiqun;Li Wenchan;Yao Zhiming;Yang Jihong(Department of Nephrology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Nuclear Medicine,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院肾内科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [2]北京医院核医学科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730

出　　处：《中华肾脏病杂志》2021年第6期481-489,共9页Chinese Journal of Nephrology

基　　金：北京市科委首都市民健康项目培育(Z13110200400000)。

摘　　要：目的比较几种基于血肌酐计算的估算肾小球滤过率(estimated glomerular filtration rate,eGFR)公式在60岁以上老年慢性肾脏病(chronic kidney disease,CKD)患者中应用的优劣。方法入选2012年1月至2017年10月在北京医院就诊、年龄≥60岁的CKD患者为研究对象。采用99m锝-二乙三胺五乙酸(99mTc-DTPA)肾动态显像法测量肾小球滤过率(glomerular filtration rate,GFR)并作为参照标准,依据测量的肾小球滤过率(measured GFR,mGFR)值分为4组:mGFR<30 ml·min^(-1)·(1.73 m^(2))^(-1)组、30≤mGFR<45 ml·min^(-1)·(1.73 m^(2))^(-1)组、45≤mGFR<60 ml·min^(-1)·(1.73 m^(2))^(-1)组和mGFR≥60 ml·min^(-1)·(1.73 m^(2))^(-1)组。用Bland-Altman散点图比较各公式计算得出的eGFR值与mGFR值间的偏差,以eGFR在mGFR(1±30%)内的比例(P30)和均方根误差(RMSE)评估各公式的准确性。采用Wilcoxon配对秩和检验比较各公式间的偏差,McNemar检验比较各公式间P30的差异。结果共628例CKD患者入选本研究,中位年龄为76.0(71.0,81.0)岁,中位血肌酐和mGFR分别为110.0(86.0,152.0)μmol/L和42.90(29.88,55.68)ml·min^(-1)·(1.73 m^(2))^(-1)。基于血肌酐计算的各eGFR公式均有不同程度地高估GFR,其中柏林倡议研究方程(BIS)公式和全年龄段(FAS)公式的准确性较好(P30分别为68.3%和68.0%),其次为加入了中国种族系数的慢性肾脏病流行病学协作组(C-CKD-EPI)公式(P30为65.4%),其余公式准确性均欠佳。偏差方面,C-CKD-EPI公式最优(0.27)。mGFR<30 ml·min^(-1)·(1.73 m^(2))^(-1)组中,所有公式的准确性均欠佳,FAS公式的准确性略优于其他公式,P30为51.0%。在30≤mGFR<45 ml·min^(-1)·(1.73 m^(2))^(-1)组中,C-CKD-EPI公式的偏差最小(3.11);准确性方面,BIS公式和FAS公式略优于其他公式,P30分别为64.6%和63.0%。45≤mGFR<60 ml·min^(-1)·(1.73 m^(2))^(-1)组中,C-CKD-EPI公式的偏差最小(0.72),BIS公式的准确性最佳,P30为82.5%,其次为FAS公式,P30为79.7%。mGFR≥60 ml·min^(-1)·(1.73 mObjective To compare the advantages and disadvantages of several formulas for estimated glomerular filtration rate(eGFR)based on serum creatinine in elderly patients with chronic kidney disease(CKD)over 60 years old.Methods CKD patients aged≥60 years old in Beijing Hospital from January 2012 to October 2017 were selected as subjects.Measured glomerular filtration rate(mGFR)was detected by 99mTc-DTPA renal dynamic imaging and used as a reference standard.According to the mGFR value,the patients were divided into 4 groups:mGFR<30 ml·min^(-1)·(1.73 m^(2))^(-1) group,30≤mGFR<45 ml·min^(-1)·(1.73 m^(2))^(-1) group,45≤mGFR<60 ml·min^(-1)·(1.73 m^(2))^(-1) group and mGFR≥60 ml·min^(-1)·(1.73 m^(2))^(-1) group.The deviation of each formula was compared by Bland-Altman scatter chart,and the accuracy of each formula was evaluated by the proportion of eGFR within mGFR(1±30%)(P30)and root mean square error(RMSE).Wilcoxon paired rank sum test was used to compare the deviation of each formula,and McNemar test was used to compare the difference of P30 among these formulas.Results A total of 628 patients with CKD were enrolled in this study.The median age was 76.0(71.0,81.0)years old.The median serum creatinine and mGFR were 110.0(86.0,152.0)μmol/L and 42.90(29.88,55.68)ml·min^(-1)·(1.73 m^(2))^(-1),respectively.Each eGFR formula based on serum creatinine overestimated glomerular filtration rate in varying degrees.Among them,the accuracy of Berlin Initiative Study(BIS)formula and full age spectrum(FAS)formula was the best(P30 were 68.3%and 68.0%respectively),followed by the Chinese race coefficient of Chronic Kidney Disease Epidemiology Collaboration(C-CKD-EPI)formula(P30 was 65.4%).The accuracy of the other formulas was poor.In terms of deviation,C-CKD-EPI formula was the best(0.27).In the group of mGFR<30 ml·min^(-1)·(1.73 m^(2))^(-1),the accuracy of all formulas was poor,and the accuracy of FAS formula was slightly better than that of other formulas(P30 was 51.0%).In the group of 30≤mGFR<45 ml·min^(-1

关 键 词：老年人 肾小球滤过率 肾功能不全 慢性 公式 估算肾小球滤过率 

分 类 号：R692[医药卫生—泌尿科学]