不同体表面积标准化方法在老年患者Gate’s法测算GFR中的适用性研究

The Application Study of Different BSA Normalization Methods in the Evaluation of GFR by Gate's in Elder Patients

目的:以双血浆法为参考标准,评估不同体表面积(BSA)标准化方法在老年患者Gate’s法测算肾小球滤过率(GFR)中的适用性研究。方法:91例在我院行双血浆法以及肾动态显像检查的老年患者纳入本研究,分别计算获得t GFR0和g GFR0(未行BSA标准化)。根据不同BSA标准化方法(Du Bois公式,Gehan and George公式,Stevenson公式,胡咏梅公式,胡咏梅提出的性别分开计算公式),分别计算并记录为g GFR1-5和t GFR1-5。以双血浆法为参考标准,进行t GFRx与g GFRx的相关性分析。根据体重指数(BMI)将患者分为正常及过轻组(A组,42例)和过重及肥胖组(B组,49例),将相应g GFR记录为g GFRx-a和g GFRx-b,并分别与t GFRx-a和t GFRx-a进行相关性分析。结果:t GFR0与g GFR0的相关性系数r0=0.723,t GFR1-5与不同BSA标准化后的g GFR1-5相关系数r1-5分别为0.721,0.719,0.720,0.718,0.751,差异具有统计学意义(P值均=0.000)。亚组分析结果显示:A组t GFR与g GFR相关性普遍较好,t GFR与g GFR相关性良好,相关系数r0-5a分别为0.817,0.828,0.827,0.828,0.826,0.841,但相关系数最高者为使用第5种BSA标准化公式后获得的g GFR,r5-a=0.841(P<0.05)。B组t GFR与g GFR相关性均较差,相关系数r0-5b分别为0.634,0.626,0.620,0.623,0.621,0.678,均具有统计学意义(P<0.05)。结论:在计算GFR方面,Gate’s法与99mTc-DTPA双血浆法具有较好相关性,但是过重或肥胖患者GFR的准确评估仍为临床难点问题,需要以患者实际情况为基础,进行综合判断。

Objective： To compare the application value of different BSA normalization methods in the evaluation of GFR by Gate＇s in elder patients. Methods： The clinical data of 91 cases of patients who performed double plasma clearance method （tGFR0） and renography examination （gGFR0） were selected in our study. According to different formulas （DuBois formula, Gehan and Georgeformula, Stevensonformula, Flu Yongmei formula, Hu Yongmei -gender correction formula）, the GFR~.5 were calculated. The correlation of tGFRx and gGF1Lx were analyzed. The patients were divided into two subgroups according to BMI （ group a and group b）, and gGFR were recorded as gGFRx-a and gGFRx-b and its correlation with tGFRx-a or tGFRx-b were analyzed. Results： The correlation of tGFR and gGFR was good in whole study cohort, and rs-a = 0.841, which was highest among all paired groups （P 〈 0.05）. The correlation of tGFR and gGFR in group b was worse （P 〈 0.05）. Conclusion： The evaluation of GFR by Gate＇s method is well correlated with tGFR, but it is still a difficult clinical question for the GFR evaluation of fat patients, which needs a large sample size of validation.