2种BSA公式和15种eGFR公式的临床适用性

The applicability of 15 eGFR formulas and 2 BSA formulas in wstimating GFR

目的探讨15种估算肾小球滤过率（GFR）的计算公式对评估患者分期的准确性,从而建立适合该院的GFR正常参考范围。方法检索该院肾脏内科2012年1月至2014年1月207例慢性肾脏病（CKD）患者作为患者组,检测其肌酐（Cr）和胱抑素C（Cys C）。不使用体表面积（BSA）标化,使用许文生计算公式（Stevenson）和杜波依斯计算公式（DuBois）标化体表面积计算GFR的3种情况,将Cr和Cys C检测值代入15个评估肾小球滤过率公式（eGFR）,所求的GFR按K/DOQ I指南中的标准进行分期。通过计算加权Kappa值比较分期与临床诊断原始分期的一致性。检索该院同期234例健康体检者,将其Cr值代入健康对照组选定的eGFR公式,计算出95%GFR参考值范围。结果 DuBois公式标化的体表面积[（1.63±0.179）m2]大于Stevenson公式标化的体表面积[1.66±0.171]m2],差异有统计学意义（P〈0.05）。组间和组内的eGFR、CKD分期差异均有统计学意义（P〈0.05）,但组间加权Kappa差异无统计学意义（P〉0.05）。基于Cr的C-G公式（eGFR1）,中国eGFR课题协助组方程4（eGFR4）以及Cys C和Cr的中国eGFR课题协作组方程比其他eGFR公式具有更好的准确性。GFR的95%生物参考区间初步确定为：80~153mL/min（中国eGFR协作组方程公式）。结论本研究选择出最适合该院的eGFR公式和GFR正常参考范围。

Objective To assessment the accuracy of the 15 kinds calculation formula of GFR for evaluating patients with stage and to establish the normal reference range for our hospital preliminary.Methods We searched207inpatients′creatinine and Cys-C measurement values from January 2012 to January 2014 in Nephrology of our hospital.In 3cases,no indexing,indexing GFR for BSA based on the formula of DuBois and indexing GFR for BSA based on the formula of Stevenson,the Crea and Cys-C measurement values are substituted into 15 eGFR formulas then eGFRs are calculated.Staging again by K/DOQI guide standards.We compared the consistency of restaging and the original staging of clinical diagnosis by the weighted kappa value.Then we selected the most suitable eGFR formula for our hospital.234 creatinine measurement values of medical patients in Healthy Ministry of our hospital from January 2013 to January 2014 will be substituted into the selected eGFR to obtain 95% GFR reference range.Results BSA_DuBois（1.63±0.179m2）is slightly larger than BSA_Stevenson（1.66±0.171）m2.There was a significant difference between the two kinds（P〈0.05）.In 3cases of indexing GFR,eGFRs and CKD stages among 3groups and within each group were significant differences,but not weightedκvalues of significant differences among the 3groups.Creatinine-based C-G formula,China eGFR topics Collaborative Group Equations,based Cys-C and creatinine China eGFR topics Collaborative Group Equations compared to other eGFR formulas have better accuracy.In the case of no indexing for BSA,95% reference interval of eGFR4 is 80-153mL/min.Conclusion This study selected the most suitable for the hospital of eGFR formula and GFR normal reference range.