新疆地区汉族与维吾尔族肾移植受者GFR评估的种族差异性研究

A Study of Race Differences in Estimated GFR and Application of Evaluated GFR Equations in Uygur and Han renal transplant recipients in Xinjiang

目的通过评估基于肌酐eGFR方程与基于胱抑素、基于肌酐联合胱抑素的肾小球滤过率评估方程在新疆地区汉族及维吾尔族移植肾受者中的差异性,寻求适用于新疆地区汉族及维吾尔族移植肾受者的GFR评估方程。方法在新疆地区维吾尔族与汉族肾移植受者中,以99Tcm-DPTA法测定的mGFR值作为参考标准,对基于肌酐的EPI_(SCr)、使用了亚洲人种系数的EPI_(SCr)方程、EPIcys_C、EPIcys_C三变量方程、EPI_(SCr)+cys_C、中国北大EPI_(SCr)+cys_C方程的诊断价值、偏差、精密度、准确度、相关性、预测CKD进行了表现进行比较、评估。结果在汉族肾移植受者各e GFR方程与m GFR比较均高估了GFR,在维吾尔族肾移植受者,除了EPIScys方程及EPI Scys3变量方程以外,其余各e GFR方程均高估了GFR。肾移植人群汉族与维吾尔族肌酐、m GFR水平一致,但在胱抑素浓度上表现出差异。汉族肾移植受者中EPIScys方程诊断价值最高,与m GFR相关性最强;维吾尔族肾移植受者中EPIScys三变量方程诊断价值最高,与mGFR相关性最强,但这些方程的准确度均欠佳。未调整混杂因素前EPIScys方程、EPIScys3变量方程维吾尔族相对汉族患CKD风险增加,去除混杂因素前、后维吾尔族相对于汉族患CKD风险均存在差异。结论在本研究中证实了汉族肾移植受者中EPIScys方程表现最佳,维吾尔族肾移植受者中EPIScys三变量方程表现最佳,但这些方程的准确度欠佳。这些表现相对最佳的方程仍然不能够完全适用于新疆地区汉族及维吾尔族肾移植受者,在临床实践中仍然需要寻求一个更合适的GFR评估方程。

Objective Applicability of EPISCr,EPISCr corrected by Asian coefficients,cysC-based estimated equations and Cr combine eysC-based estimated equations among Han and Uygur renal transplant recipients in Xinjiang were evaluated,and the best equations among Han and Uygur renal transplant recipients were confirmed.Methods GFR was determined according to 99Tcm-DPTA and it was as standard.Diagnostic value,bias,precision,accuracy and correlation of EPISCr with or without Asian coefficients,EPIcysC,EPIoysC with three variable,EPISCr＋cysC and China special eGFRSCr＋cysC equations were compared.Results GFR was overestimated when all of eGFR equations were compared with mGFR in Han renal transplant recipients.GFR was also overestimated except for EPIcyC and EPIcysC with three variable in Uygur renal transplant recipients.There were no differences in Cr and mGFR levels between Hart and Uygur renal transplant recipients,however,Cys C concentration were quite different.EPIcysC,showing best correlations with mGFR,had highest diagnostic value in Han renal transplant recipients.EPIcysC with three variable had highest diagnostic value and had best correlations with mGFR in Uygur renal transplant recipients.However,the accuracy of both of equations were not ideal.There were significant risk differences in having CKD between Han and Uygur renal transplant recipients with or without adjusted confounding factors.Conclusion EPIcysC had the best performance for Han renal transplant recipients,and EPIcysC with three variable had the best performance for Uygur renal transplant recipients.But these equations were not enough suitable for Han and Uygur renal transplant recipients in Xinjiang.More appropriate eGFR equations in clinical practice are required,