肾小球滤过率预测公式在2型糖尿病患者中的应用

Application of Glomerular Filtration Rate Prediction Formulae in Diabetic Patients

目的对基于血清肌酐(creatinine,crea)的肾小球滤过率(glomerular filtration rate,GFR)预测式在糖尿病患者中的预测性能进行比较。筛选出适用于糖尿病患者的eGFR预测式,并结合临床进行适用性分析评价。方法收集本院125例2型糖尿病患者的有关资料。以二乙三胺五醋酸(Dicthygl-Triamine-Penta Aceticarid,DTPA)肾脏清除率作为本研究GFR检测的参考值(rGFR),基于crea的水平,分别对GFR预测公式〔本研究选择简化的美国肾脏病膳食改良实验(aMDRD)公式及慢性肾脏病流行病学合作研究(CKD-EPI)公式〕所获的预测值(eGFR)的偏差、精密度、准确度及诊断敏感性进行比较。并以rGFR<90和<60mL/(min.1.73m2)作为诊断界点,结合临床进行ROC曲线分析。结果两公式所获eGFR与rGFR相比,偏差均有统计学意义(P<0.05)。两公式间包括eGFR、偏差、精密度、30%准确性、50%准确性在内的各预测指标差异无统计学意义。但是根据eGFR与rGFR的散点图分析,在使用aMDRD公式时,2例rGFR>90mL/(min.1.73m2)的患者所获eGFR严重偏离rGFR(离群值),而这种情况在使用CKD-EPI公式时并未出现。ROC曲线分析可见,aMDRD或CKD-EPI公式单独使用其AUC都介于0.8～0.9之间,而结合患者临床资料后,将蛋白尿的出现同时作为诊断依据之一时,aMDRD和CKD-EPI公式的AUC都接近或超过0.9,AUC较之前单独使用时AUC的差异有统计学意义(P<0.05)。结论基于血清crea水平的aMDRD公式及CKD-EPI公式均适用于2型糖尿病患者eGFR的预测,而CKD-EPI公式可能在早期肾损伤时具有较好的稳定的预测性能;联合患者蛋白尿出现情况有利于提高eGFR预测公式的诊断效能。

Objective To compare the predictive performances of glomerular filtration rate （GFR） prediction formulae based on serum crea level in diabetic patients and to determine their clinical application values. Methods Fasting serum crea of 125 diabetic patients in Chengdu were detected. 99m Tc-DTPA clearance rate was used as the reference test （rGFR）. The eGFR was obtained using different formulae （aMDRD and CKD-EPI formula in this study）. The bias, precision, accuracy and diagnostic sensitivity of the two formulae were compared. ROC curve analyses were performed with different diagnostic boundary points 〈rGFR,〈90 or 〈60 mL/（min 〈 1.73z）]. Results Significant differences between eGFR and rGFR were found with both formulae （P 〈 0. 05）. There were no significant differences in the predict performance between the two formulae in terms of bias, precision and accuracy within 30% and 50%. Two cases with higher than 90 mL/（min · 1.732） rGFR were identified as outliers using aMDRD formula according to the eGFR-rGFR scatterplot analysis. The ROC curve analysis showed that the AUC were in the range between 0.8 and 0.9. The AUC approached 0.9 when proteinuria was taken into consideration for both formulae, and this involved a significant improvement （P〈0.05）. Conclusion Both aMDRD and CKD-EPI formulae predict eGFR accurately in diabetic patients. However, the CKD-EPI formula may have better stability in predicting eGFR in patients at an early stage of renal injury. Combined use of proteinuria may improve the diagnostic performance of eGFR prediction formulae.