肾动态显像法与MDRD改良方程法在慢性肾脏病患者分期中的价值比较

Comparison of renal dynamic imaging and modified MDRD equation in determining the stage of chronic kidney disease patients

目的 评价、比较肾动态显像法与肾脏病膳食改良试验（MDRD）改良方程法两种方法在慢性肾脏病（CKD）患者分期中的准确率,确定临床实践中首选的分期方法.方法 对169例CKD患者同时采用双血浆法、肾动态显像法与MDRD改良方程法测定肾小球滤过率（GFR）,以双血浆法测定的GFR作为“金标准”对患者进行分期,统计分析肾动态显像法与MDRD改良方程法在CKD患者分期中的准确率,并根据分期比较两种方法在各期中的准确率.结果 在纳入的共169例CKD患者中,肾动态显像法分期的准确率为56.80％,MDRD改良方程法的准确率为68.64％,二者的差异有统计学意义（P=0.019＜0.05）.根据分期对各期准确率的比较发现,两种方法仅对肾衰竭期患者的分期准确率差异有统计学意义（P=0.012＜0.05）,而对其他各期患者的分期准确率差异均无统计学意义（P分别为0.180、0.424、0.629和0.754,均＞0.05）.结论 MDRD改良方程法对CKD患者分期的准确率要优于肾动态显像法,其优越性主要体现在对肾衰竭期患者的分期中,而对其他各期的患者,两种方法的分期准确率差异则无统计学意义,然而,由于MDRD改良方程法更加简便、经济,临床实践中对CKD患者进行分期应首选MDRD改良方程法.

Objective To compare the accuracy of 99Tcm-diethylene triamine pentaacetic acid （99Tcm-DTPA） renal dynamic imaging and modified modification of diet in renal disease trail （MDRD）equation in determining the stage of the chronic kidney disease （CKD） patients in clinical practice.Methods A total of 169 patients were enrolled whose glomeruar filtration rate （GFR） were determined simultaneously by 3 methods：dual plasma sample clearance method,renal dynamic imaging and modified MDRD equation.The dual plasma sample clearance method was employed as the reference method.The accuracy of the other methods in determining the stage of CKD patients was compared and the comparison was repeated based on the different stages.Results The accuracy of renal dynamic imaging and modified MDRD equation was 56.80％ and 68.64％,respectively （P=0.019＜0.05）.And only in the stage of uremia,the difference of the above-mentioned two method reached statistical significance （P=0.012＜0.05）,while in other stages they showed similar performance （P=0.180,0.424,0.629 and 0.754,all P＞0.05）.Conclusion Modified MDRD equation showed better performance than renal dynamic imaging or as good as the second one in determining the stage of CKD patients and the former one should be the first choice in clinical practice because of its simplicity and economy.