肾小球滤过率评估方程在2型糖尿病患者中的应用

The application of glomerular fitration rate evaluation equation in patients with type 2 diabetes

目的 观察慢性肾脏病流行合作组（CKD-EPI）方程、糖尿病膳食改良实验（简化MDRD）方程及苦味酸法校正至酶法（MDRD-IDMS）方程估算T2DM患者肾小球滤过率（GFR）的适用性. 方法 T2DM患者188例,用上述方程计算eGFR,与肾动态显像测得的GFR进行比较,分析eGFR在不同肾功能分期的适用性. 结果 CKD-EPI方程的偏差[-9.40 ml/（min·1.73 m2）]小于简化MDRD[-12.61 ml/（min·1.73 m2）]及MDRD-IDMS[-10.20 ml/（min·1.73m2）].其30％、50％符合率（53.7％、80.3％）高于简化MDRD（45.7％、71.3％）及MDRD-IDMS（50.7％、76.1％）（P＜0.01）.诊断肾功能不全受试者工作特征（ROC）曲线下面积以CKD-EPI方程最高（0.928）,效能最好.在不同肾功能分期中,CKD-EPI方程在糖尿病慢性肾脏疾病（CKD）1～2期有较低的偏差及更好的准确性,MDRD-IDMS与简化MDRD方程分别在CKD 3期、CKD 4～5期为优. 结论 3种方程均存在不同程度的偏差;相对而言,CKD-EPI方程可能更适合评估T2DM患者的eGFR.

Objective To observe the application of CKD-EPI equation, simplified MDRD equation and MDRD-IDMS equation to predict glomerular filtration rate （GFR） in patients with type 2 diabetes. Methods A total of 188 cases of type 2 diabetes patients were included. Equations mentioned above were used to calculate eGFR,which was compared with the value of GFR measured by renal dynamic imaging. At the same time,the applicability of eGFR at different stages of renal function was analyzed. Results The deviation of CKD-EPI equation [-9.40 ml/（min·1.73 m^ 2）] was lower than in simplified MDRD [-12.61 ml/（min·1.73 m^ 2）]and MDRD-IDMS [-10.20 ml/（min·1.73 m^ 2）]. 30%and 50% coincidence rates of CKD-EPI equation （53.7%,80. 3%） were higher than in simplified MDRD （45.7%, 71.3%） and MDRD-IDMS （50.7%, 76.1%） （P〈0.01）. The area under ROC curves of CKD-EPI equation was second to none （0. 928）, and its performance was the best in diagnosis of renal dysfunction of subjects. At different stages of renal function,CKIN-EPI equation had lower deviation and better accuracy in stage 1-2 of chronic kidney disease （CKD）, while MDRD-IDMS equation and simplified equation were optimal in stage 3 and stage 4-5 of CKD, respectively. Conclusion There were different degrees of deviation in three equations, relatively speaking, CKD-EPI equation was more suitable for assessment ofeGFR of patients with type 2 diabetes.