中国肾小球滤过率评估方程在慢性肾小球肾炎患者的适用性评价

Evaluation on Modified Glomerular Filtration Rate Estimation Equations in Chronic Glomerulonephritis

目的:评价现有在中国人群基础上开发的肾小球滤过率(GFR)评估方程在慢性肾小球肾炎患者的适用性。方法:选择143例慢性肾小球肾炎患者,用中国方程、瑞金方程、MDRD1方程和简化MDRD方程,分别计算GFR值,与99mTc-DTPA测的GFR(sGFR)进行比较。结果:Bland-Altman分析显示MDRD1方程和瑞金方程估计的GFR和sGFR的一致性较好,但所有各方程估计的GFR和sGFR的一致性限度均超过事先规定的专业界值。线性回归结果显示,MDRD1方程和瑞金方程估测的GFR与x轴的斜率较其他方程更接近0。在所有方程中,MDRD1方程和中国9方程偏差较小,瑞金方程估测GFR30%符合率和50%符合率均最高,但瑞金方程估测GFR30%符合率依然低于70%。在慢性肾脏病不同分期中,瑞金方程和MDRD1方程较其他方程有较小的偏差和更优的准确性。结论:当血肌酐的测定方法为酶法时,如直接应用现有在中国人群基础上开发的肾小球滤过率评估方程评估慢性肾小球肾炎患者肾功能,可能会产生明显的偏差。

Objective： To evaluate the applicability of modified equation based on Glomerular filtration rate（GFR） in Chinese patients with chronic glomerulonephritis. Methods： A total of 143 chronic glomerulonephritis patients were investigated. GFR was estimated with Chinese equation, Ruijin equation, MDRDI equation and abbreviated MDRD equation separately. The accuracy of estimated GFRs was compared with ^99mTc- DTPA - GFR （sGFR） in chronic glomerulonephritis patients. Results：Bland - Altman analysis demonstrated that the GFR estimated by MDRD1 equation and Ruijin equation were more consistent with sGFR than the other equations. But all the GFR were not well consistent with sGFR. Linear regressions showed that the slopes of MDRD1 equation and Ruijin equation were closer to the identical line. 30% and 50% accuracies of Ruijin equation were higher than the other equations. But 30% accuracy of Ruijin equation was less than 70%. When the accuracy of estimated GFRs was compared with sGFR in different stages of CKD, GFR estimated by Ruijin equation and MDRD1 equation showed less bias and higher accurate than other equations.Conclusion： When plasma creatinine was checked with the enzymatic method, modified GFR estimation equations may show great bias in Chinese chronic glomerulonephritis patients.