以双血浆法为标准评估肾动态显像法与CKD-EPI公式法测定老年慢性肾病患者肾小球滤过率的临床应用研究

The Clinical Application of CKD-EPI Collaboration and Gate's Equation on the Evaluation of GFR of Elderly Patient with CKD by Taking Double-plasma-sample Method for Reference

目的对比分析^(99)Tc^m-DTPA肾动态显像法(Gate's法)与CKD-EPI SCr公式法判定老年患者GFR的临床适用性,探索性地建立基于双血浆法以及不同检查方法的回归模型。方法收集我院2011年4月至2013年1月行双血浆法(tGFR)以及Gate's测量GFR的老年患者资料72例,以双血浆法为参考标准,对比分析CKD-EPI Scr公式(eGFR)以及Gate's法(g GFR)测量GFR的准确性。结果 tGFR与gGFR的相关性较好(r=0.724),与eGFR的相关性较差(r=0.632),差异具有统计学意义(P<0.05)。3~5期老年CKD患者的tGFR与eGFR和gGFR之间均具有较好相关性,相关系数分别为0.736和0.749(P<0.05)。结论 Gate's法在老年CKD患者GFR的评估中显示出了较为准确的结果,但仍不推荐作为各种临床公式评估GFR的参考标准。Gate's法和CKD-EPI Scr均可以对3~4期老年CKD患者的GFR进行准确评估,但老年CKD患者GFR的评估仍需要以患者实际情况为基础,进行综合判断。

Objective To compare the accuracy of CKD-EPI collaboration and Gate＇s equation on the evaluation of GFR of elderly patient with CKD by taking double- plasma- sample method for reference, and to explore the establishment of regression models. Methods 72cases of elderly patients with CKD from April 2011 to January 2013 who were performed with both 99mTc-DTPA renal dynamic imaging and double- plasma-sample method were selected in our study. The accuracy of CKD-EPI collaboration and Gate＇s equation on the evaluation of GFR of elderly patient with CKD were compared by taking double-plasma- sample method for reference. Results The correlation between tGFR and gGFR was relatively high （r = 0. 724）, the correlation between tGFR and eGFR was low （r = 0. 632 ）, and the difference was statistically significant（ P 〈 0.05 ）. The correlation between tGFR and eGFR or gGFR in stage 3 -5 CKD elderly patients were both high, and the correlation coefficients were 0.736 - 0.749, respectively （ P 〈 0.05 ）. Conclusion Gate＇s equation can evaluate the GFR of elderly patients more accurately, but it is not recommended to be used as a method for reference of other formula＇ comparison. Both CKD-EPI collaboration and Gate＇s equation can accurately be used in stage 3 -5 CKD elderly patients, meanwhile when evaluating the GFR of elderly patients, comprehensive judgment is needed.