CKD-EPI与MDRD肾小球滤过率评估公式在慢性肾脏病患者中的适用性研究

Application of CKD-EPI and MDRD Estimation Equations for Glomerular Filtration Rate in Chronic Kidney Disease

目的比较慢性肾脏病流行病学合作研究(CKD-EPI)公式、简化MDRD公式和中国改良的简化MDRD公式预测中国慢性肾脏病(CKD)患者肾小球滤过率(glomerular filtration rate,GFR)的适用性。方法选择我院2010年1—4月住院的非外籍CKD患者87例,监测其血清肌酐(Scr)水平,同时行99mTc-DTPA肾动态显像检查,测得的GFR(rGFR)作为参考标准,用CKD-EPI公式、简化MDRD公式和中国改良的简化MDRD公式计算估测的GFR。分析估测的GFR与参考值(rGFR)的相关性,并就3种公式估测的GFR的估测偏差、精确度、准确率及诊断敏感性进行比较。结果 3种肾小球滤过率评估公式估测的GFR与rGFR间的估测偏差、估测偏差绝对值及估测偏差百分位数比较差异均无统计学意义(P>0.05);15%、30%及50%准确率间比较差异亦无统计学意义(P>0.05)。CKD-EPI公式较MDRD公式可显示出较好的精确度及预测能力。3种公式估测的GFR与rGFR在总体及rGFR<60 ml.min-1.(1.73 m2)-1时显示明显的相关性。当分别以90或60 ml.min-1.(1.73 m2)-1作为诊断分界点时,受试者工作特征曲线(ROC)曲线下面积比较差异无统计学意义。结论 CKD-EPI公式较MDRD公式有较好的预测能力,但能否更准确地评估我国CKD患者的GFR及取代MDRD公式,尚需进一步研究。

Objective To evaluate the applicability of CKD-EPI equation and simplified MDRD equation and refitted MDRD equation applicable to Chinese to predicate glomerular filtration rate（GFR） from serum creatinine in Chinese patients with chronic kidney disease（CKD）.Methods A total of 87 non-foreign CKD patients hospitalized in our hospital from January to April,2010 were investigated.Serum creatinine（Scr） level and renal clearance rate of 99mTc-DTPA were measured in all patients,the value of GFR（rGFR） gained being used as the reference standard for the afterwards comparison with the estimated GFR gained through CKD-EPI equation,simplified MDRD equation,and refitted MDRD equation applicable to Chinese,respectively.Then,the correlation analysis was made between estimated GFR and rGFR,and the deviation,precision,accuracy,and diagnostic sensitivity of three equations were also compared.Results The estimated GFR being compared with rGFR,no significant differences were found in deviation,its absolute value,and its percentage（P0.05）,which was the same for 15%,30%,and 50% accuracies（P0.05）.CKD-EPI equation showed better accuracy and predictive power than MDRD equation.There was an significant correlation between GFR and rGFR both in general and when rGFR60 ml·min-1·（1.73m2）-1.There were no significant differences of the area under ROC curve between the two point with 90 or 60ml·min-1·（1.73m2）-1as the diagnostic cut-off point.Conclusion Although CKD-EPI equation shows better predictive power,it still needs further studies to prove whether it can estimate GFR more accurately and replace MDRD for Chinese patients with chronic kidney disease（CKD）.