不同肾小球滤过率估算公式评估危重症孕产妇肾功能适用性分析  

Analysis of the applicability of different glomerular filtration rate estimation formulas in assessing renal function in critically ill pregnant women

作　　者：陈晨[1] 李国福[1] CHEN Chen;LI Guo-fu(Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院,辽宁沈阳110004

出　　处：《中国实用妇科与产科杂志》2025年第3期343-347,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：民生科技辽宁省联合项目(2021JH2/10300097)。

摘　　要：目的初步筛选出更适合用于中国危重症孕产妇肾小球滤过率估算值评估的公式,以便快速准确地评估危重症孕产妇肾损伤程度,及早发现急性肾损伤(AKI),保障危重孕产妇及围产儿的生命安全。方法以2016年1月至2020年12月于中国医科大学附属盛京医院重症监护病房住院的危重孕产妇为研究对象,根据改善全球肾脏病预后组织(KDIGO)AKI指南定义的AKI诊断标准确定患者是否患有AKI,使用常见的C-G公式、简化MDRD公式、BIS-1公式和FAS公式绘制受试者工作特征(ROC)曲线,评价各公式诊断AKI的效能。根据年龄、孕产史、孕周分亚组,评价各公式在亚组内部的诊断效能是否一致。结果在总体危重症孕产妇中,简化MDRD公式诊断AKI敏感度最高,为65.48%。按年龄、孕产史、孕周分亚组,在年龄<35岁的亚组中,AUC值最高为FAS公式的0.669;在年龄≥35岁的亚组中,AUC值最高为C-G公式的0.872。在初产妇中,BIS-1公式的AUC值最高,达到0.692;在经产妇中FAS公式的AUC值最高,达到0.738。在孕周<37周亚组中,AUC值较高的为FAS公式的0.736和简化MDRD公式的0.734,而敏感度最高的为简化MDRD公式和BIS-1公式的63.49%;在孕周≥37周亚组中,各公式AUC值均有所下降,其中C-G公式和BIS-1公式AUC值相对较高。结论在总人群中,推荐敏感度高的简化MDRD公式。年龄<35岁者推荐使用FAS公式,年龄≥35岁者推荐使用C-G公式、FAS公式和简化MDRD公式。初产妇推荐使用BIS-1公式,经产妇推荐使用FAS公式。孕周<37周者推荐使用简化MDRD公式,孕周≥37周者推荐使用C-G公式和BIS-1公式。目前各公式用于评估危重症孕产妇肾功能都存在一定的缺陷,应尽可能地根据中国人群情况,制定有中国特点的肾小球滤过率估算公式。Objective This study intends to initially select a formula more suitable for eGFR assessment in critically ill women in China,In order to quickly and accurately assess the degree of kidney injury,early detection of AKI,to ensure the life safety of critically ill pregnant women and perinatal infants.Methods In this study,The critically ill pregnant women who were hospitalized in the intensive care unit of Shengjing Hospital Affiliated to China Medical University from January 2016 to December 2020 were studied,To diagnose AKI by using the KDIGO criteria,using the Cockroft-Gault formula、the simplified MDRD Formula,the FAS formula and the BIS-1 formula were used to draw ROC curves to evalu-ate the efficacy of each formula in diagnose AKI.According to age,gestational history and gestational age,to evaluate the diagnostic efficacy of each formula within the subgroups.Results Among the overall critically ill mothers,the simpli-fied MDRD formula had the highest sensitivity of 65.48%.By age,gestational history and gestational age,in the subgroup aged<35 years,the highest AUC value was 0.669 of the FAS formula.In the subgroup of age 35 years,the highest AUC value was 0.872 for the C-G formula.In primigravous women,BIS-1 formula had the highest AUC value reaching 0.692 and in multiparous women FAS formula had the highest AUC value reaching 0.738.In the subgroup of<37 weeks,the higher AUC value was 0.736 of the FAS formula and 0.734 of the simplified MDRD formula,while the highest sensitivity was 63.49%of the simplified MDRD formula and BIS-1 formula;in the subgroup of 37 weeks of gestation,the AUC value of each formula decreased,in which the C-G formula and BIS-1 formula were relatively high.Conclusions This study shows that simplified MDRD formulas with high sensitivity are recommended in the total population.In the subgroup with age<35 years,the FAS formula is recommended,and in those with age 35 years,the C-G formula,the FAS formula,and the simplified MDRD formula are recommended.BIS-1 formula was used in primipara and

关 键 词：危重孕产妇 重症监护病房 急性肾损伤 肾小球滤过率估算公式 

分 类 号：R714.25[医药卫生—妇产科学]