半胱氨酸蛋白酶抑制剂C肾小球滤过率公式在妇科肿瘤化疗患者中的应用评价

Evaluation of CysC-based estimation formulae of glomemlar filtration rate in chemotherapy of gynaecological tumor

目的评估基于半胱氨酸蛋白酶抑制剂C(CysC)的Hoek、Orebro、Larsson、Filler、Rule、Gruub、MacIsaac、Steven和Hojs公式对妇科肿瘤化疗患者肾小球滤过率(GFR)的预测性能。方法使用胶乳增强免疫透射颗粒比浊法测定妇科肿瘤连续化疗患者下次化疗前血清CysC浓度;同时行同位素99mTc-DTPA肾功能显象检查。以体表面积标准化的99mTcDTPA测得同位素GFR(iGFR)为金标准,采用线性相关分析比较CysC和各公式Hoek、Orebro、Larsson、Filler、Rule、Gruub、MacIsaac、Steven、Hojs预测的GFR(eGFR)与iGFR相关性;应用Bland-Altman分析比较各公式估测eGFR与iGFR一致性;应用配对t检验及15%、30%、50%符合率比较它们偏差和准确度;同时应用受试者工作特征(ROC)曲线比较它们在GFR降低中的诊断效能。结果①CysC与rGFR有相关性(r=-0.425,P<0.01)。②各方程的eGFR均与iGFR有相关性(P<0.01)。Filler、Hojs公式预测eGFR与iGFR进行配对t检验,偏差差异无统计学意义,其余各公式预测eGFR分别与iGFR的偏差差异均有统计学意义(P<0.05);Filler、MacIsaac、Hojs的eGFR的15%、30%、50%符合率较高。③MacIsaac、Hoek、Rule估测的eGFR与iGFR的一致性较好,所有公式估测的eGFR与iGFR的一致性限度均超过预定的界值。④Hoek、Orebro、Larsson、Filler、Rule、MacIsaac、Hojs公式与Gruub估测eGFR的ROC曲线下面积(AUC)差异均有统计学意义(P<0.05),9种公式的eGFR的AUC均大于CysC(P<0.05)。结论 9种GFR公式估算的eGFR均存在不同程度的误差,在今后广泛用于临床前,所有公式仍需进一步进行校正。

Objective To evaluate the prediction performance of Hock, Orebro, Larsson, Filler, Rule, Gruub, Maclsaac, Steven and Hojs formulae based on the serum cystain C for the calculation of glomemlar filtration rate（GFR） in chemotherapy of gynecological tumor. Methods The serum levels of eystain C （CysC） were determined by latex enhanced immunoturbidimetrie method, GFR was measured by 99mTc-DTPA renal dynamic imaging in 46 patients （80 cycles） in chemotherapy of gynecological tumor. Isotopic GFR （iGFR） which was predicted with body surface area standardized were served as the gold standard. The correlation among CysC, all estimated GFRs （eGFRs）of formulae and iGFR were compared by linear analysis. The consistency of all eGFRs and iGFR was compared by Bland and Altman procedures. The bias and accuracy of all eGFRs and iGFR were compared by t paired test and 15% ,30% ,50% coincidences. The diagnostic efficacy of all eGFRs and iGFR was compared by receiver operatingcharacteristic （ROC） curves. Results （1） There was relation of CysC and iGFR （r = -0. 425, P 〈 0. 01 ）. （2） There was relation of eGFRs and iGFR （P 〈 0. 01 ）. There was no significant difference for Filler and Hojs between eGFR and iGFR. There was higher coincidence of Filler, Maelsaac and Hojs formulae than the others. （3） There was higher consistency of Maclsaac, Hock, Rule formulae with iGFR than other formulae, but all eGFRs were above the limit point. （4） There was significant difference of the area under receiver operating characteristic curve （AUC） of eGFRs among Hock, Orebro, Larsson, Filler, Rule, Maclsaac, Hojs and Gruub （P 〈 0.05 ）. All the AUC of eGFRs was larger than that of CysC （P 〈 0. 05 ）. Conclusion There are bias in all the eGFR formulae in estimating actual GFR, and all the formulae should be amended when applied in future clinical practice.