5种肾小球滤过率估算公式评估危重患者肾功能的精确度与准确度  

The precision and accuracy of five equations for estimated glomerular filtration rate in evaluating renal function in critically ill patients

作　　者：曾汉杰 黄敏 张倩 朱冬梅 周苏明 ZENG Hanjie;HUANG Min;ZHANG Qian;ZHU Dongmei;ZHOU Suming(Geriatric ICU,Jiangsu Province Hospital,the First Affiliated Hospital With Nanjing Medical University,Nanjing 210029,Jiangsu,China)

机构地区：[1]南京医科大学第一附属医院(江苏省人民医院)老年ICU,江苏南京210029

出　　处：《实用医学杂志》2025年第8期1243-1252,共10页The Journal of Practical Medicine

基　　金：江苏省老年医学临床技术应用研究项目(编号:LD2021002);江苏省干部保健科研课题项目(编号:BJ18015)。

摘　　要：目的比较慢性肾脏病流行病学合作研究组(CKD-EPI)公式、美国肾脏病膳食改良试验简化(aMDRD)公式、Cockcroft-Gault(G-C)公式、梅奥诊所二次(MCQ)公式及柏林倡议研究(BIS)公式,在评估危重症患者肾脏功能中的表现并探讨临床应用中最适合的方法。方法纳入2020年6月至2022年6月在南京医科大学第一附属医院(江苏省人民医院)老年医学科重症监护病房住院的危重症患者,分别采用CKD-EPI公式、aMDRD公式、C-G公式、MCQ公式及BIS1公式与24 h肌酐清除率(CrCl_(24h))进行比较,分析各个公式在入院48 h内评估危重症患者肾功能的精确度和准确度。结果共534例患者纳入研究。(1)aMDRD公式的偏倚最小(3.91),5种估算肾小球滤过率(estimated glomerular filtration rate,eGFR)公式的准确度均较低,分别为44.4%、42.9%、63.1%、44.9%和54.9%。(2)CKD-EPI公式、aMDRD公式、C-G公式、MCQ公式、BIS1公式对患者肾功能的分级与CrCl_(24h)的一致性加权κ值分别为0.464、0.555、0.403、0.405、0.159(P<0.001)。CKD-EPI公式倾向于高估肾功能中至重度下降患者的分级,低估肾功能正常患者的分级。aMDRD公式、MCQ公式、BIS1公式均倾向于高估肾功能减退患者的分级,低估肾功能正常患者的分级。C-G公式倾向于低估肾功能正常及肾功能轻至中度下降患者的分级。(3)对于肾功能明显下降的患者[CrCl_(24h)≤60 mL/(min·1.73 m^(2))],C-G公式的eGFR值最低,BIS1公式的eGFR值最高。对于肾功能正常至中度下降的患者[60 mL/(min·1.73 m^(2))24h≤130 mL/(min·1.73 m^(2))],C-G公式的eGFR值依然最低,而MCQ公式的eGFR值最高。对于肾功能亢进的患者[CrCl_(24h)>130 mL/(min·1.73 m^(2))],BIS1公式的eGFR值最低,aMDRD公式的eGFR值最高。(4)患者肾功能明显减退[CrCl_(24h)≤60 mL/(min·1.73 m^(2))]或肾功能亢进[CrCl_(24h)>130 mL/(min·1.73 m^(2))]时,CKD-EPI及MCQ公式准确度下降。aMDRD公式的准确度随患者肌酐清除率升�Objective To evaluate and compare the performance of the Chronic Kidney Disease Epidemi⁃ology Collaboration(CKD-EPI)equation,the abbreviated Modification of Diet in Renal Disease(aMDRD)equa⁃tion,the Cockroft-Gault(C-G)formula,the Mayo Clinic Quadratic(MCQ)equation,and the Berlin Initiative Study 1(BIS1)equation in determining renal function among critically ill patients,and to identify the most appro⁃priate method for clinical application.Methods Critically ill patients admitted to the Intensive Care Units of the Department of Geriatric Medicine at the First Affiliated Hospital of Nanjing Medical University(Jiangsu Province Hospital)between June 2020 and June 2022 were included.Their renal function was assessed within 48 hours of admission using the 24-hour creatinine clearance rate(CrCl_(24h))as the reference standard,and compared with the CKD-EPI equation,aMDRD equation,C-G formula,MCQ equation,and BIS1 equation.The precision and accuracy of each equation in evaluating renal function in critically ill patients were analyzed.Results Total of 534 patients were included in the study.(1)The aMDRD equation exhibited the least bias(-3.91),yet the accuracy of the five estimated glomerular filtration rate(eGFR)equations was relatively low,ranging from 42.9%to 63.1%.(2)For renal function grading,the weightedκagreement values between the CKD-EPI equation,aMDRD equation,C-G formula,MCQ equation,BIS1 equation,and CrCl_(24h)were 0.464,0.555,0.403,0.405,and 0.159,respectively(all P<0.001).(3)Among patients with severe kidney function decline[CrCl_(24h)≤60 mL/(min·1.73 m^(2))],the eGFR value derived from the C-G formula was the lowest,while that from the BIS1 equation was the highest.In patients with normal or moderately reduced renal function[60 mL/(min·1.73 m^(2))<CrCl_(24h)≤130 mL/(min·1.73 m^(2))],the eGFR value of the C-G formula remained the lowest,whereas the MCQ equation yielded the highest eGFR value.For patients with augmented renal function[CrCl_(24h)>130 mL/(min·1.73 m^(2))],the eGFR value of the BI

关 键 词：危重症患者 24 h肌酐清除率 肾小球滤过率估算公式 肾功能 

分 类 号：R692[医药卫生—泌尿科学]