CKD-EPI公式在我国老年慢性肾脏病患者中的适应性研究

Application of CKD-EPI equation to estimate glomerular filtration rate in Chinese elderly patients with chronic kidney disease

目的 探讨慢性肾脏病流行病学合作研究（CKD-EPI）公式在中国65岁以上老年慢性肾脏病（CKD）患者中评估肾小球滤过率（GFR）的适用性及其应用价值,为临床评估CKD患者GFR提供一定的依据.方法 选择我院老年肾脏病科CKD患者146例作为研究对象.首先采用CKD-EPI公式计算eGFR,然后予标准化GFR进行相关性分析.结果 相关性分析提示eGFR与sGFR呈正相关（r =0.776,P＜ 0.01）.不论在总体的适用性,还是以60ml·min^-1· （1.73m^2）-1为分界点时：CKD-EPI公式得出的eGFR与sGFR均显示明显的相关性.eGFR与sGFR的平均偏差为（-1.79±13.42）ml·min^-1·（1.73 m^2）-1（配对t检验,t=1.249,P=0.214）,当sGFR＞60 ml·min^-1·（1.73 m^2）-1时偏差较大,偏差值为（-3.03±11.11）ml·min^-1·（1.73m^2）-1,当sGFR＜60 ml·min^-1·（1.73 m^2）-1时,偏差较小,偏差值为（-0.70±14.27） ml·min^-1·（1.73 m^2）-1,但偏差均无统计学意义（P＞0.05）.eGFR的15％、30％及50％符合率分别为43.15％、69.86％和86.99％.其中sGFR＞60 ml·min^-1·（1.73 m^2）-1时符合率较好,分别为60.47％、93.02％及100％,而sGFR＜60 ml·min^-1·（1.73m^2）-1时符合率稍差,分别是34.95％、60.19％及81.55％.结论 CKD-EPI公式在应用于我国65岁以上老年CKD患者评估GFR时,准确性较高,CKD-EPI公式在评估较高的GFR时,与sGFR偏差较小,说明在老年CKD患者中CKD-EPI公式有低估GFR的倾向,其评估中国65岁以上老年CKD患者GFR的适用性尚需进一步扩大样本量,以协作组的方式进行大规模研究.

Objective To evaluate the applicability of Chronic Kidney Disease Epidemiology Collaboration （CKD-EPI） equation to estimate glomerular filtration rate in Chinese elderly patients （≥ 65） with chronic kidney disease.Method 146 elderly patients （≥ 65） with CKD were evaluated for the correlation between eGFR and sGFR.Results Correlation analysis revealed eGFR was positively correlated with sGFR （r =0.776,P 〈 0.01）.The significant correlation between eGFR and sGFR existed both when sGFR 〈 60 ml/（min · 1.73 m^2） and when sGFR 〉 60 ml/（min · 1.73 m^2）.Average deviation of eGFR from sGFR was （-1.79 ± 13.42） ml/（min · 1.73 m^2）.There was no significantly statistical deviation both in general and the point with 60 ml/（min · 1.73 m^2） as the diagnostic cut-off point.15%,30% and 50% coincidence rates of eGFR were 43.15%,69.86% and 86.99% respectively.The coincidence rate of eGFR in sGFR 〉 60 ml/（min · 1.73 m^2） was higher than that in sGFR 〈 60 ml/（min · 1.73 m^2）.Conclusions CKD-EPI equation has a less deviation and a higher accuracy for evaluation of GFR in elderly patients （≥ 65） with CKD.When estimating GFR at higher values,it may be underestimated by CKD-EPI equation.So,more prospective and multiple medical center should include large subjects to further assess the usefulness of CKF-EPI equation in estimating GFR in Chinese elderly patients （≥ 65） with CKD.