肾小球滤过率评估公式在糖尿病患者中的适用性分析

Evaluating these equations to estimate glomerular filtration rate in patients with diabetes

目的评价常用的肾小球滤过率评估公式在我国2型糖尿病患者中的临床适用性。方法选择住院的2型糖尿病患者163例，将^99mTc—DTPA肾动态显像测定肾小球滤过率作为参考值（Standard GFR，sGFR），用简化MDRD、Cockcroft—Gauh（CG）、CKD—EPI公式计算GFR评估值，将不同公式估测的GFR与GFR参考值（sGFR）进行比较。结果（1）简化MDRD与CKD—EPI公式均高估患者GFR水平，但CKD—EPI评估值偏离程度小于简化MDRD公式；（2）当sGFR≥60ml／min时，C—G公式评估值明显低于sGFR，当sGFR〈60ml／min时，C—G公式评估值明显高于sGFR，与简化MDRD与CKD—EPI公式相比，C—G公式偏离程度较小；（3）CKD—EPI公式评估值在慢性肾脏病Ⅰ、Ⅱ期的患者中与sGFR符合度高，而在慢性肾脏病Ⅲ～Ⅴ期的患者中，C—G公式与sGFR符合度较高。结论CKD—EPI与C—G公式评估糖尿病患者GFR优于简化MDRD公式，其中CKD—EPI公式适用于CKDⅠ～Ⅱ患者，而C—G公式适用于慢性肾脏病Ⅲ～Ⅴ期患者。

Objective To evaluate the applicability of these equations to predict glomerular filtration rate（GFR） from serum creatinine in Chinese diabetic patients. Methods A total of 163 hospitalized diabetic patients （age 〉 18） were investigated. ^99mTc-DTPA plasma clearance was calculated and standardized by body surface area（sGFR）. GFRs estimated with abbreviated MDRD equation, Cockcroft- Gault equation and CKD-EPI equation were compared with sGFR. Results （ 1 ） Both Abbreviated MDRD equation and CKD-EPI equation seemed to systematically overestimate GFR,but the bias of CKD-EPI e- quation was smaller than Cockeroft-Gault equation. （2） cGFR was significantly higher than sGFR when sGFR≥60 ml/min and lower than sGFR when sGFR 〈 60 ml/min. The bias of Cockcroft-Gauh equation was smaller than Abbreviated MDRD equation and CKD-EPI equation. （3） The accuraney of CKD-EPI equation was better than others when sGFR≥60 ml/min,while the accurancy of Cockcrofi-Gauh equation was better when sGFR 〈 60 ml/min. Conclusion The CKD-EPI equation and Cockcroft-Gauh equation can estimate GFR accurately. CKD-EPI equation applies to CKD Ⅰ - Ⅱ patients,while the C-G equation applicable to patients with CKD Ⅲ - Ⅴ.