^(99m)Tc-DTPA肾动态显像、简化MDRD方程及CKD-EPI方程评价慢性肾脏病患者肾功能的比较

Comparison of GFR calculation methods:^(99m)Tc-DTPA renal dynamic imaging,abbreviated MDRD and CKD-EPI equations in patients with chronic kidney disease

目的比较99mTc-DTPA肾动态显像(Gates'法)、简化MDRD方程及CKD-EPI方程评价慢性肾脏病(CKD)患者肾小球滤过率(GFR)的价值。方法选择CKD成人患者159例,以双血浆法测定的GFR(rGFR)作为参照,应用Pearson相关分析及Bland-Altman分析比较Gates'法、简化MDRD方程及CKD-EPI方程估算的GFR(eGFR)的相关性、一致性及准确性。结果 Gates'法估测的eGFR与rGFR呈正相关(r=0.900,P<0.001),高于简化MDRD方程(r=0.816,P<0.001)及CKD-EPI方程(r=0.825,P<0.001)。3种方法都低估了rGFR值,但是Gates'法的偏差最小[-3.4 mL/(min·1.73 m2)]、精确度最高[11.8 mL/(min·1.73 m2)]、±30%的准确性最高(71.7%)。除了CKD1~2期,Gates'法±30%的准确性均高于简化MDRD方程及CKD-EPI方程(P<0.05)。简化MDRD方程与CKD-EPI方程准确性比较差异无统计学意义(P>0.05)。结论 3种方法均低估了rGFR。CKD-EPI方程并不优于简化MDRD方程。Gates'法的准确性高于其他两种方程。

Objective To compare the applications of renal dynamic imaging with ^99mTc-DTPA（ Gates＇ method）,abbreviated MDRD（ aMDRD） equation and CKD-EPI equation in renal function assessment in the patients with chronic kidney disease（ CKD）.Methods A total of 159 adult patients with CKD were included.The glomerular filtration rate（ GFR） obtained by Gates＇ method,aMDRD equation and CKD-EPI equation against99mTc-DTPA dual plasma clearance（ rGFR） with Pearson correlational analyses and Bland-Altman method were performed.Results A statistically significant correlation was found between rGFR and Gates＇ method（ r = 0.900,P〈0.001）,which was higher than aMDRD formula（ r = 0.816,P〈0.001） and CKD-EPI formula（ r = 0.825,P〈0.001）.Bland-Altman analysis showed that all equations underestimated the rGFR in the overall performance,but Gates＇ method had less bias [-3.4 mL /（ min·1.73 m^2） ],good precision [11.8 mL/（ min·1.73 m^2） ],and greatest accuracy within ± 30% of rGFR（ 71.7%） than aMDRD and CKD-EPI equations.In each stage of CKD,excepting patients in Stage 1 Stage 2,a statistically significant higher accuracy within ± 30% was found of the Gates＇ method compared to the accuracy of the aMDRD formula or CKD-EPI formula（ P〈0.05）.No difference between the accuracies of the aMDRD formula and the CKD-EPI formula was found（ P〈0.05）.Conclusion All three methods underestimate the rGFR,the new CDK-EPI equation performs no better than aMDRD equation.Both equations can＇t provide as much accuracy as Gates＇ method.