8种肾小球滤过率方程在肾癌术后病人中的临床应用及评价  

Clinical application and evaluation of eight estimation equations for glomerular filtration rate in patients with post-operative renal carcinoma

作　　者：郑丹萍[1] 翟文佳[1] 崔健 张姝 梁艳彩[1] ZHENG Dan-ping;ZHAI Wen-jia;CUI Jian;ZHANG Shu;LIANG Yan-cai(International Medical Servives,Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]北京协和医院国际医疗部,北京100730

出　　处：《蚌埠医学院学报》2022年第12期1667-1672,1677,共7页Journal of Bengbu Medical College

基　　金：中央高校基本科研业务费专项基金资助项目(3332018042)。

摘　　要：目的:评价8种不同估算肾小球滤过率(eGFR)方程在肾癌病人肾功能评价中的适用性。方法:纳入行手术治疗的肾癌病人237例,以^(99m)Tc-DTPA肾动态显像测定肾小球滤过率(GFR)作为参考标准(rGFR),与临床中具有一定代表性以肌酐为指标的8个eGFR估算方程做比较,并根据体质量指数(BMI)、年龄、rGFR等进行分组,评估其是否影响eGFR估算方程与rGFR的一致性。结果:与rGFR相比,8种方程中除湘雅方程略低估GFR外,其他公式均高估GFR值,在总体及不同组别的比较中湘雅方程估算的eGFR的准确性及精确性均最高,其次为改良CKD-EPI(EPI-cn),而G-C方程的准确性及精确性最差。而在不同rGFR分组中,EPI方程估算的eGFR在rGFR>90 mL·min^(-1)·1.73m^(-2)组中与rGFR的一致性最好;湘雅方程在rGFR 60~90 mL·min^(-1)·1.73m^(-2)组中的准确性及精确性最佳;而在rGFR<90 mL·min^(-1)·1.73m^(-2)组中,各方程均呈现明显高估状态。8个估算方程中虽湘雅方程的准确性及精确性最好,但其准确性(P30值)也仅为69.54%,总体与rGFR的一致性仍欠佳。结论:不同eGFR公式评估肾癌病人肾功能与rGFR存在着一定的差异性,尤其在肾功能下降时。建议术前肾功能评估尽可能采用肾动态显像。对于术后肾功能的监测可联合参考EPI公式及湘雅公式估算的eGFR,同时重点关注eGFR的下降率。Objective:To evaluate the diagnostic performances of eight estimation equations for estimated glomerular filtration rate(eGFR)in patients with post-operative renal carcinoma.Methods:A total of 237 patients with post-operative renal carcinoma were included as study objects.The glomerular filtration rate(GFR)measured by ^(99m)Tc-DTPA renal dynamic imaging as reference(rGFR)were compared with the eight eGFR estimation equations respectively.Patients were divided into different groups according to body mass index,age,rGFR ect.,and the clinical applicability of various equations in each group was compared.Results:Compared with rGFR,the GFR values were overestimated by all the other equations except Xiangya equation.The eGFR from the Xiangya equation demonstrated the highest precision and accuracy in whole population and almost all subgroups,followed by modified CKD-EPI equation(EPI-cn),while the G-C equation showed the poorest predictive value in precision and accuracy.The eGFR from EPI equation had the highest consistency with rGFR in rGFR>90 mL·min^(-1)·1.73m^(-2)group;Xiangya equation demonstrated the best predictive value in rGFR 60-90 mL·min^(-1)·1.73m^(-2)group;in the rGFR<60 mL·min^(-1)·1.73m^(-2)group,all equations were significantly overestimated.The P30 value of Xiangya equation,which had the highest precision and accuracy in all estimation equations,was only 69.54%,and the overall consistency with rGFR was still poor.Conclusions:There are some differences between eGFR from the equations and rGFR,especially when renal function declines.Renal dynamic imaging should be used in the preoperative renal function evaluation.The EPI and Xiangya equations should be applied together in the estimation of eGFR in postoperative renal function,and the impact of eGFR decline rate on the predictive value needs extra attention.

关 键 词：肾肿瘤 肾小球滤过率 评估方程 

分 类 号：R737.11[医药卫生—肿瘤]