不同肾小球滤过率评估方程在2型糖尿病患者中的适用性

Comparative performance of the equations for estimating GFR in type 2 diabetic patients

选择在本院住院糖尿病患者390例，男210例，女180例，年龄（62±16）岁，以酶法测定血清肌酐，分别采用Cockcroft—Gauh公式、MDRD7方程、简化MDRD方程、国人校正后的MDRD方程（c-7GFR。方程和c—aGFR。方程）以及CKD—EPI方程计算并用体表面积（BSA）校正得到eGFR值，将所得结果与标准化的显像法测得的^99mTc—GFR进行相关和回归分析，一致性检验及受试者工作特性曲线分析。Bland—Ahman分析显示，CKD—EPI方程计算的eGFR值与^99mTc—GFR的一致性较好，较其他方程有较小的偏差和更优的精确度。Cockcroft—Gault公式、MDRD7方程、简化MDRD方程、c-7GFR。方程、c—aGFR。方程及CKD—EPI方程计算的eGFR值与^99mTc—GFR的相关系数分别为0．79、0．76、0．77、0．76、0．76、0．81；与^99mTc—GFR差值的均数分别为-14．99、-18．85、-23．79、-25．85、-32．07、-7．16；ROC曲线下面积为0．91、0．88、0．89、0．88、0．90、0．92；Kappa值为0．67、0．52、0．39、0．49、0．46、0．54。在上述GFR估算公式中CKD—EPI公式与^99mTc—GFR的相关系数最高，差值的均数较小，ROC曲线下面积最大，其次为Cockcroft-Gault公式。血清肌酐以酶法测定时，CKD—EPI公式和C—G公式较适合我国2型糖尿病患者eGFR的评估。

Serum creatinine was determined by enzymatic method. ^99mTc-GFR was measured by ^99mTc- DTPA dynamic renal imaging and considered as GFR marker in 210 males and 180 females with type 2 diabetes, eGFR was calculated by Cockcroft-Gauh formula, MDRD equation7, abbreviated MDRD equation, modified MDRD equation for Chinese （c-7GFR4 and c-aGFR4 ）, and CKD-EPI equation. They were analyzed by correlation, regression, Bland-Ahman analysis and receiver operating characteristic （ROC） curve analysis. The correlation coefficients for Cockcroft-Gauh formula, MDRD equation7, abbreviated MDRD equation, c-7GFR4, c-aGFR4, and CKD-EPI equation were 0.79, 0.76, 0.77, 0.76, 0.76, 0.81 respectively. And the differences were -14.99, -18.85, -23.79, -25.85, -32.07, and -7. 16, respectively. The area under ROC curves were 0.91, 0.88, 0. 89, 0. 88, 0. 90, and 0. 92, respectively. Kappa values were 0. 67,0. 52,0. 39,0. 49,0. 46,0. 54 respectively. The CKD-EPI equation seams to be the most accurate measurement among the six methods when the serum creatinine was determined by enzymatic method in Chinese type 2 diabetic patients.