肾小球滤过率评估方程在老年糖尿病患者的临床应用评价

Clinical application of glomerular filtration rate estimation equation in elderly patients with diabetes mellitus

目的评估Cockcroft-Gault(CG)公式,简化MDRD方程及在中国人群基础上开发的肾小球滤过率(GFR)评估方程老年糖尿病(DM)患者的适用性。方法选择126例老年DM患者,用CG公式、简化MDRD公式、瑞金方程、中国MDRD方程分别预测GFR值,与体表面积标准化99mTc DTPA测的GFR(s GFR)进行比较。结果 Bland-Altman分析结果显示瑞金方程估计的GFR和sGFR的一致性最好,但所有方程估计的GFR和sGFR的一致性限度均超过事先规定的专业界限值。线性回归结果显示,瑞金方程估测的GFR与X轴的斜率较其他方程更小。在所有方程中,瑞金方程估测GFR 15%符合率、30%符合率、50%符合率均最高,CG公式、简化MDRD方程、中国MDRD方程估测GFR30%符合率依然<70%,仅瑞金方程估测GFR 30%符合率为70.6%。在慢性肾脏疾病(CKD)不同分期中,瑞金方程估测GFR 15%符合率、30%符合率、50%符合率均较高。结论与参考标准比较,4个估算公式对于DM患者肾功能的估算结果均不是非常理想,相比之下,瑞金方程的适用性最好。

Objective To evaluate the application of Cockcroft-Gauh（CG） formula, MDRD equation and modified formulas based on plasma creatinine levels in elderly Chinese patients with diabetes mellitus （ DM ）. Methods A total of 126 elderly DM patients were investigated. Glomerular filtration rate （GFR） was estimated with CG formula, simplified MDRD equation, Chinese MDRD equation and the Ruijin equation. Results Bland-Airman analysis demonstrated that Ruijin equation was more consistent with sGFR than the other equations. However, all equations were not well consistent with sGFR. Linear regressions showed that the slope of the Ruijin equation was closer to the identical line. The 15% ,30% ,50% accuracies of Ruijin equation were higher than those of the other equations, but the 30% accuracy of CG formula, simplified MDRD equation, Chinese MDRD equation were still less than 70%, only the 30% accuracy of Ruijin equation was 70. 6%. Conclusion Compared with the reference standard, four equations show a lower degree of accuracy. The Ruijin equation shows a little better than other equations in elderly Chinese patients with DM.