EZSCAN风险评分在肾功能轻度损伤人群中的筛查价值  

Value of EZSCAN for Screening Mild Renal Impairment

作　　者：沈国丽[1] 邵敏[1] 蔡如意 孙婷[1] SHEN Guo-li;SHAO Min;CAI Ru-yi;SUN Ting(Health Management Center,The Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院健康管理中心,浙江杭州310009

出　　处：《中山大学学报（医学科学版）》2023年第1期115-121,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：浙江省自然科学基金(LGF22H070001)。

摘　　要：【目的】自主神经功能障碍是慢性肾脏病(CKD)患者常见严重的并发症,且在CKD早期就会发生。汗腺功能障碍已被视为自主神经功能紊乱的初始组成部分。通过反向离子电渗疗法和计时电流法测量电化学皮肤电导(ESC)来评估汗腺功能,可能会检测出健康体检人群中轻度肾功能不全的患者,以便给予早期干预与治疗,延缓肾功能进一步恶化。【方法】EZSCAN分数(0~100)是基于计时电流分析的专有算法计算得出的。本研究入组了2020年1月至10月浙江大学医学院附属第二医院体检中心健康体检的6 661名受试者,包括肾功能下降[估算肾小球滤过率(eGFR)<90 mL·min^(-1)·1.73 m^(-2)]的2 075(31.15%)名受试者作为病例组和肾功能正常(90 mL·min^(-1)·1.73 m^(-2)≤eGFR≤120 mL·min^(-1)·1.73 m^(-2))的4 586(68.85%)名受试者作为对照组。采用lasso回归筛选协变量,通过loess曲线和logistic回归分析风险评分与eGFR的关系。【结果】经过多变量调整后,风险评分与eGFR下降的风险相关,与risk值最低组(Q1<24)相比,Q2(25-27),Q3(28-47),Q4(48-75)的OR(95%CI)分别为1.84(1.54,2.20),2.47(2.08,2.94),2.41(2.05,2.83)。其中模型Ⅲ的ROC曲线下面积最大0.75(0.74,0.76),得出敏感度为73.98%,特异度为63%,阳性预测值为47.49%,阴性预测值为84.25%,约登指数为0.369 72,最佳截断值为25。【结论】EZSCAN是一种有效的筛选工具,可用于识别肾功能下降风险增加的健康体检人群,分数大于25应行相关实验室检测明确诊断。【Objective】 Autonomic dysfunction is a common and serious complication in patients with early chronic kidney disease(CKD). Sweat gland dysfunction is an initial sign of autonomic dysfunction. Electrochemical skin conductance(ESC) measurement by reverse iontophoresis and chronoamperometry to assess sweat gland function may detect patients with mild renal insufficiency in healthy population for early intervention and treatment to delay further deterioration of renal function.【Methods】 An EZSCAN score(0~100) was calculated using a proprietary algorithm based on the chronoamperometry analysis. A total of 6 661 subjects who received physical examination from the physical examination center of the Second Affiliated Hospital of Zhejiang University School of Medicine from January to October 2020 were enrolled, including 2 075(31.15%) subjects with reduced renal function(eGFR < 90 mL·min^(-1)·1.73 m^(-2)) as the case group and 4 586(68.85%) subjects with normal renal function(90 mL·min^(-1)·1.73 m^(-2)≤ eGFR ≤120 mL·min^(-1)·1.73 m^(-2)) as the control group. Lasso regression was used to screen covariates, and the relationship between the risk score and eGFR was analyzed by loess curve and logistic regression.【Results】 After multivariate adjustment, the risk score was correlated with the risk of eGFR decline. Compared with the group with the lowest risk value(Q1<24), the OR(95%CI)of Q2(25-27), Q3(28-47), and Q4(48-75) were 1.85(1.55, 2.21), 2.53(2.13, 3.00), 2.49(2.13, 2.93), respectively. The maximum area under the ROC curve is 0.75(0.74,0.76), the sensitivity is 73.98%, the specificity is 63%, the positive predictive value is 47.49%, the negative predictive value is 84.25%, and the Youden index is 0.369 72, the optimal cutoff value is 25.【Conclusions】 EZSCAN could be a useful screening tool to identify healthy individuals at increased risk of renal function decline, and the one with an EZSCAN score of more than 25% should undergo diagnostic laboratory testing.

关 键 词：无创筛查技术 肾功能损伤 肾小球滤过率下降 

分 类 号：R277.5[医药卫生—中医学]