肾小球滤过率评价糖尿病患者肾功能的意义及方法学比较

Significance of glomerular filtration rate in evaluating renal function of diabetic subjects and comparative study of methods thereof

目的评价 Cockcroft-Gault 公式及简化肾脏病膳食改良试验(MDRD)公式计算的肾小球滤过率对于糖尿病患者肾功能估计的适用性。方法测定189例2型糖尿病患者血肌酐浓度,对两种公式计算的肾小球滤过率分别与^(99)Tc^m-DTPA(^(99)Tc^m标记的二乙三胺五乙酸)肾动态显像测定的肾小球滤过率(金标准)进行比较,以便评价筛选出更为适用于糖尿病患者肾功能估计的公式。结果两种公式对于 GFR 的计算均偏离于实际值,Cockcroft-Gault 公式过低估计了实际值,而简化 MDRD 公式过高估计了实际值。相关分析、一致性检验及受试者工作特性曲线分析表明,简化 MDRD 公式与金标准的相关系数、一致率及准确性均高于 Cockcroft-Gault 公式。结论对于糖尿病患者肾功能的估计,简化 MDRD 公式优于 Cockcroft-Gault 公式。

Objective To evaluate the applicability of the Cockcroft-Gauh equation and the abbreviated Modification of diet in Renal Disease （MDRD） study equation to estimate the renal function of diabetic patients. Methods Glomerular filtration rates measured by these two equations were compared with the value of GFR measured by 99Tcm-DTPA dynamic renal Imaging （considered as gold standard）, to determine which equation is more appropriate in the subjects with diabetes. Results Both of the results of the two equations deviated from the GFR measured by 99Tcm-DTPA dynamic renal Imaging： the GFRGG result was lower and the GFRMDRD result was higher than the real GFR value. However, the correlation analysis, coherence testing, and accuracy by receiver operating characteristic curve analysis showed that the coefficient of correlation, coherence rate, and accuracy of the GFRMD formula with the gold standard were all higher than those of the GFRcG formula. Conclusion The abbreviated style of MDRD equation is more appropriate than Cockcrofi-Gault equation for the estimating of renal function in diabetic patients.