不同肾小球滤过率估计公式对体检人群肾功能的评价

Performance of different GFR equations for estimating glomerular filtration rate among professional population

目的探讨不同的肾小球滤过率（GFR）估计公式对体检人群肾功能评价的表现。方法收集8 476例职业体检者的血清肌酐、尿素氮、血清胱抑素、尿常规,分别使用慢性肾脏病流行病学合作研究（CKD-EPI）公式、基于血清胱抑素C的CKDEPI（Cys-EPI）公式、联合血清肌酐和胱抑素C的中国GFR课题组经验性（CC-EPI）公式、简化MDRD（a-MDRD）公式、中国改良的MDRD（c-MDRD）公式计算估计的GFR（eGFR）。结果体检人群中使用不同GFR公式计算出的结果之间有显著相关性（P〈0.01）。但不同公式计算出的eGFR均值差异有统计学意义（P〈0.01）,与CKD-EPI比较,c-MDRD对GFR估计值偏高（P=8.7×10-263）。不同公式计算出的eGFR〈60mL·min-1·1.73（m2）-1的个体比例差异有统计学意义（P〈0.01）,且比例差异主要集中在45~59mL·min-1·1.73（m2）-1范围内。以CKD-EPI公式计算的eGFR和蛋白尿将其分为CKD和非CKD两组。在CKD人群中,Cys-EPI、CC-EPI、c-MDRD计算出的eGFR偏高;非CKD人群中,Cys-EPI、a-MDRD公式计算的eGFR较低,c-MDRD公式计算出的eGFR明显偏高,而CC-EPI公式结果与CKD-EPI公式最接近。结论不同GFR估算公式对体检人群计算出的eGFR值有显著相关性,但是各公式在CKD和非CKD两组间的表现又有明显差异。

Objective To evaluate the performance of different GFR equations in estimating renal function of people undertake health examination.Methods A total of 8 476 occupational physical examination population were selected.Serum creatinine,urea nitrogen,serum cystatin and urine routine of all cases were collected to be used to calculate eGFR through different GFR equations of the Chronic Kidney Disease Epidemiology Collaboration（CKD-EPI）equation.,the equation based on cystatin C（Cys-EPI）,the combined creatinine-cystatin C equation（CC-EPI）,simplified MDRD equtation（a-MDRD）,modified eGFR equation for Chinese patients（c-MDRD）.Results There was a significant correlation among physical examination population using different GFR equations calculated results（P〈0.01）.But comparisons the means of eGFR calculated by different equations are statistical significant（P〈0.01）.Comparing with CKD-EPI,the eGFR calculated by c-MDRD is higher（P=8.7×10-263）.The ratios of population,eGFR60mL·min^-1·1.73（m2）^-1 by different equations,have significant difference（P〈0.01）.And the ratio difference is more concentrated in the range Of 45-59mL·min^-1·1.73（m2）^-1.Devide the populations into two groups,which are chronic kidney disease（CKD）and Non-CKD according to the standard of eGFR and Urine protein by CKD-EPI.Among CKD,the eGFR calculated by Cys-EPI,CC-EPI,c-MDRD are higher;but among non-CKD group,eGFR calculated by Cys-EPI,a-MDR are lower,the eGFR of c-MDRD is significantly higher,while the result of CC-EPI is most close to the CKD-EPI.Conclusion There were significant correlations between the different equations to calculate GFR among physical examination population.