应用99Tcm-DTPA肾动态显像结果评估不同肾小球滤过率估算方程的诊断效能  

Evaluation diagnostic efficacy of different glomerular filtration rate estimation equations by using 99Tcm-DTPA renal dynamic imaging results

作　　者：朱平 李林 邢芝静 郝玉杰 慕玉东 施常备 周舒玲 ZHU Ping;LI Lin;XING Zhi-jing;HAO Yu-jie;MU Yu-dong;SHI Chang-bei;ZHOU Shu-ling(Shaanxi University of Chinese Medicine,Xianyang 712046,Shaanxi,China;Shaanxi Provincial Cancer Hospital,Xi’an 710061,Shaanxi,China;Xijing University,Xi’an 710123,Shaanxi,China;Department of Imaging,Xi’an Hospital of Traditional Chinese Medicine,Xi’an 710021,Shaanxi,China)

机构地区：[1]陕西中医药大学,陕西咸阳712046 [2]陕西省肿瘤医院,陕西西安710061 [3]西京学院,陕西西安710123 [4]西安市中医医院影像科,陕西西安710021

出　　处：《生物医学工程与临床》2025年第2期205-212,共8页Biomedical Engineering and Clinical Medicine

基　　金：陕西省重点科技厅项目(2024SF-YBXM-226)。

摘　　要：目的以99m锝-二乙烯三胺五乙酸(99Tcm-DTPA)肾动态显像测得的肾小球滤过率(mGFR)为标准,分析评估11种具有代表性的肾小球滤过率估算(eGFR)方程的诊断效能。方法应用11种估算方程计算eGFR,通过均值、偏倚、精密度、准确度(P15、P30)、一致性来评估11种估算方程在肾功能评估中的诊断效能。结果在肾功能总体评估中,湘雅方程的精密度、准确度、一致性最优;偏倚最小的前3个方程依次为CKD-EPI2012CysC方程、FASCysC方程、FASScr-CysC方程,这3个方程与mGFR均值差异无统计学意义(P>0.05);改良肾脏病饮食改良研究(MDRD)方程均值和偏倚最大,与mGFR均值差异有统计学意义(P<0.05),准确度最小,且与湘雅方程、CKD-EPI2012CysC方程、FASCysC方程相比,差异有显著统计学意义(P<0.01);FASScr-CysC方程与99Tcm-DTPA肾动态显像结果相关性最高。在肾功能不全时,受试者工作特性(ROC)曲线分析显示FASCysC方程ROC曲线下面积(AUC)最大,且与Cockcroft-Gault方程差异有显著统计学意义(P<0.01),与其他方程差异无统计学意义(P>0.05);CKD-EPI2012Scr-CysC方程特异度最高;改良MDRD方程灵敏度最高;FASScr-CysC方程约登指数最大。结论在肾功能总体评估中,不同的eGFR方程存在差异性,但湘雅方程、CKD-EPI2012CysC方程、FASCysC方程、FASScr-CysC方程表现出较好的诊断效能;在肾功能不全时,FASCysC方程、CKD-EPI2012Scr-CysC方程、FASScr-CysC方程、改良MDRD方程表现出较好的诊断效能。Objective To analyze and evaluate the diagnostic efficacy of 11 representative estimate glomerular filtration rate(eGFR)equations by using measured glomerular filtration rate(mGFR)of 99Tcm-DTPA renal dynamic imaging as the standard.Methods Eleven estimation equations were used to calculate eGFR,and diagnostic efficacy of those estimation equations in renal function evaluation was evaluated by mean value,bias,precision,accuracy(P15,P30)and consistency.Results For overall evaluation of renal function,Xiangya equation showed the best precision,accuracy and consistency.The top three equations with the least bias were CKD-EPI2012CysC equation,FASCysC equation and FASScr-CysC equation,respectively,and there was no significant difference between those 3 equations and mean mGFR(P>0.05).The mean value and bias of modified MDRD equation were the largest,the difference was statistically significant compared with mGFR(P<0.05),and the accuracy was the smallest,and there were statistically significant differences between modified MDRD equation and Xiangya equation,CKD-EPI2012CysC equation as well as FASCysC equation(P<0.01).FASScr-CysC equation showed the highest correlation with 99Tcm-DTPA renal dynamic imaging results.For renal insufficiency,the receiver operating characteristic(ROC)curve analysis showed that the area under curve(AUC)of FASCysC equation was the largest;it had statistically significant difference with Cockcroft-Gault equation(P<0.01),but not other equations(P>0.05).The specificity of CKD-EPI2012Scr-CysC equation was the highest,sensitivity of modified MDRD equation was the highest and Youden index of FASScr-CysC equation was the largest.Conclusion It is demonstrated that there are differences in different eGFR equations for overall evaluation of renal function,and the Xiangya equation,CKD-EPI2012CysC equation,FASCysC equation and FASScr-CysC equation showed better diagnostic efficiency;for renal insufficiency,FASCysC equation,CKD-EPI2012Scr-CysC equation,FASScr-CysC equation and modified MDRD equation exhibit

关 键 词：肾小球滤过率评估方程 肾小球滤过率 肌酐 胱抑素C 肾功能不全 肾动态显像 

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]