七种肾小球滤过率评估公式在肾恶性肿瘤患者适用性评估

Evaluation of seven glomerular filtration rate assessment formulas in patients with renal malignancy

目的:评估七种肾小球滤过率估算公式在肾恶性肿瘤患者中的适用性。方法:回顾分析我院2015年1月~2016年12月泌尿外科收治泌尿系统肿瘤80例,以^(99m)Tc-DTPA肾动态显像测得肾小球滤过率(GFR)且体表面积标准化后为参照标准rGFR;分别以CKD-EPI_(Scr)、CKD-EPI_(SCysC)、CKD-EPI_(Scr-SCysC)、CKD-EPI_(亚洲)、CKD-EPI_(糖尿病)、改良MDRD、简化MDRD估算肿瘤患者GFR,分别以eGFR-EPI_(Scr)、eGFR-EPI_(SCysC)、eGFR-EPI_(Scr-SCysC)、eGFR-EPI_(亚洲)、eGFR-EPI_(糖尿病)、eGFR_(改良MDRD)、eGFR_(简化MDRD)表达。分别从相关性、偏差、30%准确度、精密度及95%一致性和诊断肾功能下降受试者工作特征曲线(ROC)等方面评估七种公式在肾恶性肿瘤患者中效能。结果:(1)Scr与rGFR有相关性(r=-0.298,P=0.007),SCysC与rGFR无相关性(r=-0.154,P=0.173);(2)各预测eGFR-EPI_(Scr)、eGFR-EPI_(SCysC)、eGFR-EPI_(Scr-SCysC)、eGFR-EPI_(亚洲)、eGFR-EPI_(糖尿病)、eGFR_(改良MDRD)、eGFR_(简化MDR)值与rGFR均有相关性(r=0.434、0.282、0.383、0.421、0.506、0.429、0.426,P=0.000、0.011、0.000、0.000、0.000、0.000、0.000);(3)eGFR-EPI_(Scr)、eGFR-EPI_(亚洲)、eGFR-EPI_(糖尿病)与rGFR30%符合率最高;(4)配对t检验结果示eGFR-EPI_(Scr)、eGFR-EPI_(SCysC)、eGFR-EPI_(Scr-SCysC)、eGFR-EPI_(亚洲)、eGFR_(简化MDRD)与rGFR差异无统计学意义(P>0.05);(5)Bland-Altma结果,所有公式一致性均超过预定的界限,相比较,eGFR_(糖尿病)与rGFR一致性较好;以GFR<60ml·min^(-1)·1.73m^(-2)为诊断肾功下降全界点,ROC曲线结果显示,eGFR-EPI_(Scr)、eGFR-EPI_(SCysC)、eGFR-EPI_(Scr-SCysC)、eGFR-EPI_(亚洲)、eGFR-EPI_(糖尿病)、eGFR_(改良MDRD)、eGFR_(简化MDRD)的eGFR的曲线下面积(AUC)分别为0.808、0.684、0.765、0.781、0.848、0.792、0.797,eGFR-EPI_(Scr-SCysC)、eGFR-EPI_(Scr)、eGFR-EPI_(亚洲)、改良eGFR_(MDRD)、eGFR_(简化MDRD)、eGFR-EPI_(糖尿病)、估算eGFR敏感度较高,eGFR-EPI_(糖尿病)特异性最佳。结论:七种公式估算的eGFR均存在不同偏差,但CKD-EPI_(糖尿病)、eGFR-EPI_(Scr)、eGFR-EPI_(亚洲)、eGFR_(简化MDRD)估算GFR准确性和精确度较佳,诊断肾功能下降灵敏度、特异度较好,但尚需大样本量进一步研究修正。

Objective：To evaluate the applicability of the seven glomerular filtration rate estimation formulas in patients with renal malignancies.Method：Eighty patients with urinary system tumors treated in urology of our hospital between January 2015and December 2016were reviewed retrospectively.The glomerular filtration rate（GFR）measured by ^99mTc-DTPA renal dynamic imaging was normalized by the surface area as reference standard rGFR,GFR of tumor patients was calculated by CKD-EPIScr,CKD-EPISCysC,CKD-EPIScr-SCysC,CKD-EPIAsia,CKD-EPIdiabetes,modified MDRD and simplified MDRD were expressed as for eGFR-EPIScr,eGFR-EPISCysC,eGFR-EPIScr-SCysC,eGFR-EPIAsia,eGFR-EPIdiabetes,eGFRmodified MDRD,eGFRsimplified MDRD,respectively.The seven formulas were evaluated in terms of correlation,deviation,30%accuracy,precision and 95%consistency and diagnosis of renal function decline the receiver-operating characteristic curve（ROC）in patients with renal malignant tumor.Result：（1）There was a correlation between Scr and rGFR（r=-0.298,P=0.007）,and SCysC had no correlation with rGFR（r=-0.154,P=0.173）.（2）eGFR-EPIScr,eGFR-EPISCysC,eGFR-EPIScr-SCysC,eGFR-EPIAsia,eGFR-EPIdiabetes,eGFRmodified MDRD,eGFRsimplified MDRDwere correlated with rGFR（r=0.434,0.282,0.383,0.421,0.506,0.429,0.426,P=0.000,0.011,0.000,0.000,0.000,0.000,0.000,respectively）.（3）The coincidence rate between 30%of rGFR and eGFR-EPIScr,eGFR-EPIAsia,eGFR-EPIdiabeteswas the highest.（4）Paired t test showed there was no significant difference between eGFR-EPIScr,eGFR-EPISCysC,eGFR-EPIScr-SCysC,eGFR-EPIAsia,eGFRsimplified MDRDand rGFR（P〉0.05）.（5）Bland-Altman plot showed that all formula conformance exceeded the predetermined limit,in comparison,eGFRdiabetesand rGFR consistency is better.With GFR〈60ml·min^-1·1.73m^-2 for diagnostic point to kidney function decline,ROC curve showed that the area under the curve of eGFR-EPIScr,eGFR-EPISCysC,eGFR-EPIScr-SCysC,eGFR-EPIAsia,eGFR-EPIdiabetes,eGFRmodified MDRD,eGFRsimplified MDRDwere 0.808,0.684,0.765,0.781,0.848,0.792,0.797,respectively.The eGFR estimated by eGFR-EPIScr-SCysC,eGFR-EPIScr,eGFR-EPIAsia,eGFRmodified MDRD,eGFRsimplified MDRD,eGFR-EPIdiabetes showed the highest sensitivity,and eG-FR-EPIdiabetes showed the best specificity.Conclusion：The eGFR estimated by the seven formulas were different.However,CKD-EPIdiabetes,eGFR-EPIScr,eGFR-EPIAsia and eGFRsimplified MDRD have the better accuracy in estimating GFR,and the sensitivity and specificity of diagnosis of renal function are better.But it is necessary to further revise by increasing the sample size.