MDRD与CKD-EPI肾小球滤过率预测公式在慢性肾脏病患者中的比较

Comparison of MDRD and CKD-EPI formulae for the calculation of glomerular filtration rate in patients with chronic kidney disease

目的:比较MDRD与CKD-EPI公式对慢性肾脏病(CKD)患者肾小球滤过率(GFR)的预测性能。方法:收集成都市区136例CKD患者的有关资料,检测其血清肌酐(Scr)水平;同时行同位素Tc-DTPA肾扫描99m检查。以DTPA清除率作为本研究GFR检测的参考值(rGFR),计算Scr与rGFR的相关性,并就MDRD公式和CKD-EPI公式预测GFR(eGFR)的偏差、精密度、准确度及诊断敏感性进行比较。结果:将Scr进行标准倒数变换后,其与rGFR回归后的相关系数r=0.680。两预测公式所获eGFR分别与rGFR进行配对t检验,差异均有统计学意义(P<0.05);两预测公式所获eGFR之间差异无统计学意义。但当rGFR>60mL/(min·1.73m2)时,CKD-EPI公式偏差较小,精密度较高,30%和50%准确性高于MDRD公式;当rGFR<60mL/(min·1.73m2)时,两公式偏差和精密度差异不明显,但CKD-EPI公式30%和50%准确性低于MDRD公式。当分别以90或60mL/(min·1.73m2)作为诊断分界点时,ROC曲线下面积比较无统计学意义。结论:CKD-EPI公式适用于CKD患者GFR的预测,在rGFR>60mL/(min·1.73m2)时体现了较好的预测趋势,但是否能取代MDRD公式尚需进一步研究。

Objective To compare the predicting effects of MDRD and CKD-EPI formulae for the calculation of glomerular filtration rate （GFR） in patients with chronic kidney disease （CKD）. Methods Clinical data from 136 patients with CKD in Chengdu city were collected for the detection of serum creatinine （Scr） level and renal clearance rate of ^99mTc-DTPA which was used as the reference of glomerular filtration rate （rGFR）. Then the correlation between Scr and rGFR were calculated, and the bias, precision, accuracy, and diagnostic sensitivity of MDRD and CKD-EPI formulae for predicting GFR （eGFR） were compared. Results The correlation coefficient between 1/Scr and rGFR was 0.680. There were significant differences between eGFR and rGFR in MDRD and CKD-EPI formulae （P 〈 0.05）, and there was no significant difference of eGFR between the two formulae. When rGFR 〉 60 mL/（min· 1.73 m^2）, the bias was smaller, the precision was higher, and the 30% and 50% accuracy were higher in CKD-EPI formula than those in MDRD; but when rGFR 〈 60 mL/（min·1.73 m^2）, there were no significant differences of bias and precision, and the 30% and 50% accuracy were lower in CKD-EPI formula than those in MDRD. There were no significant differences of the area under ROC curve between the two formulae with 90 or 60 mL/（min· 1.73 m^2） as the diagnostic cut-off point. Conclusion CKD-EPI formula can be applied to GFR predicting in patients with CKD, and shows an advanced trend when rGFR 〉 60 mL/（min· 1.73 m^2）. More further studies are still needed to probe whether it could be a replacement of the MDRD formulae.