两种公式估算的肾小球滤过率对慢性心力衰竭患者远期预后预测价值比较研究  

A comparative study on the predictive value of the glomerular filtration rate estimated by two formulas in the long-term prognosis of patients with chronic heart failure

作　　者：徐霞 胡元会[1] 宋庆桥[1] 商秀洋[1] 李雨濛 佘飞 Xu Xia;Hu Yuanhui;Song Qingqiao;Shang Xiuyang;Li Yumeng;She Fei(Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;不详)

机构地区：[1]中国中医科学院广安门医院,北京100053 [2]清华大学附属北京清华长庚医院清华大学临床医学院,北京102218

出　　处：《中国循证心血管医学杂志》2022年第5期554-558,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：国家自然科学基金面上项目(81904191);中国中医科学院广安门医院所级课题(2018S420);首都卫生发展科研专项项目(2020-2-4153)。

摘　　要：目的比较两种公式计算的肾小球滤过率(eGFR)水平对慢性心力衰竭(CHF)患者全因死亡事件的预测价值。方法纳入2006年1月至2014年8月于中国中医科学院广安门医院心内科住院的CHF患者546例,使用简化肾脏病膳食改良试验(MDRD)公式及基于血肌酐水平的慢性肾脏病流行病合作研究(CKDEPI)公式分别计算e GFR,并进行分组(A组e GFR≥90 ml/min·1.73 m^(2);B组90 ml/min·1.73 m^(2)>e GFR≥60ml/min·1.73 m^(2);C组e GFR<60 ml/min·1.73 m^(2))。采用电话问卷等方式进行随访,主要研究终点为全因死亡。应用Bland-Altman图比较两种方程及一致性相关系数估算e GFR的相关性和一致性;采用受试者工作曲线(ROC)及Kaplan-Meier生存曲线评价e GFR对CHF全因死亡的预测能力;使用Cox回归风险模型估计e GFR与远期预后的相关性。结果两种公式评估eGFR值的相关性和一致性较差(P<0.0001,Pc=0.8582);两种公式单因素分析显示:三组间HR值差异具有统计学意义(P<0.05);经过校正后CKD-EPI对于肾功能中重度降低组全因死亡仍具有预测价值(P=0.011),对于肾功能轻度降低组无统计学差异(P=0.462)。经过模型校正后MDRD对于肾功能轻度降低组差异具有统计学意义(P=0.026),对于肾功能中重度降低组差异无统计学意义(P=0.182)。结论在慢性心力衰竭患者中,不同eGFR估测公式各有其远期预后预测价值使用阶段,CKD-EPI适用于中重度肾功能降低的患者,MDRD适用于肾功能轻度降低的患者。Objective To compare the predictive value of glomerular filtration rate(eGFR)levels calculated by both formulas for all-cause mortality events in patients with chronic heart failure(CHF).Methods A total of 546 CHF patients hospitalized in the Department of Cardiology,Guang'anmen Hospital,Chinese Academy of Chinese Medical Sciences,were included from January 2006 to August 2014.EGFR was calculated using the simplified dietary modification test in renal disease(MDRD)formula and the cooperative study on the epidemiology of chronic kidney disease(CKD-EPI)formula based on serum creatinine levels,respectively,and divided(EGFR≥90 ml/min×1.73 m^(2) in group A;90 ml/min×1.73 m^(2)>EGFR≥60 ml/min×1.73 m^(2) in group B;and EGFR<60 ml/min×1.73 m^(2) in group C).Follow up was performed by telephone questionnaire,and the primary endpoint was all-cause death.The correlation and consistency of EGFR were estimated by comparing the two equations and the consistency correlation coefficient using Bland Altman plots.Receiver operating curve(ROC)and Kaplan Meier survival curves were used to evaluate the predictive ability of EGFR for all-cause mortality in CHF.Cox regression risk models were used to estimate the association between EGFR and long-term outcomes.Results The correlation and consistency of the eGFR values assessed by the two formulas were poor(P<0.0001,Pc=0.8582).Univariate analysis of the two formulas showed that:the difference in the HR values among the three formulas was statistically significant(P<0.05).After adjustment,CKD-EPI was still predictive of all-cause death in the group with moderate to severe reduction of renal function(P=0.011),but not in the group with mild reduction of renal function(P=0.462).The group difference in MDRD after the model correction was statistically significant for mild decreases in renal function(P=0.026)but not for moderate to severe reductions in renal function(P=0.182).Conclusion In patients with chronic heart failure,different eGFR estimation formulas have their long-term prog

关 键 词：肾小球滤过率 慢性心力衰竭 全因死亡 远期预后 

分 类 号：R541.61[医药卫生—心血管疾病]