不同肾小球滤过率估算公式对估算慢性肾脏病患者肾小球滤过率的差异比较

Comparison of different glomerular filtration rate estimation formulas in estimating glomerular filtration rate in patients with chronic kidney disease

目的:比较不同肾小球滤过率(GFR)估算公式在估算慢性肾脏病(CKD)患者GFR中的结果差异。方法:回顾性分析195例CKD患者的血清学以及影像学资料,以99mTc-DTPA Gates法测定的GFR作为参考GFR(rGFR),比较MDRD(Modification of Diet in Renal Disease) 2003公式、MDRD 2006公式、CKD-EPI公式、BIS公式、中国公式计算得到的GFR作为估算的GFR(eGFR),比较eGFR与rGFR的相关性及偏倚、eGFR的精密度和准确度以及eGFR的误分期比例。结果:195例CKD患者rGFR水平为(72. 26±33. 18) ml·min^(-1)·1. 73 m^(-2)。各eGFR与rGFR的Pearson相关系数范围在0. 571~0. 736之间(P <0. 001),MDRD2006公式与rGFR的相关系数最高,为0. 736。MDRD2006公式与rGFR的偏倚最小,为4. 66 ml·min^(-1)·1. 73 m^(-2)。同时,MDRD2006公式的P15、P30的准确度最高,分别为33. 85%、54. 36%。Bland Altman图显示MDRD2006公式偏倚最小、精密度最高、一致性区间最小。结论:MDRD2006更适合于我国CKD患者GFR的估算,但还需大样本作为循证依据。

Objective： To compare the results of different glomerular filtration rate（GFR） estimation equations in the estimation of glomerular filtration rate in patients with chronic renal disease（ CKD）. Methods： A total of 195 patients with CKD was enrolled and analyzed in this retrospective study. The estimateGFR values（ eGFR） from Scrbased equations（ MDRD2003 equation,MDRD2006 equation,CKD-EPI equation,BIS equation,GFR equation Chinese） were compared with the referenceGFR values（ rGFR） from99 mTc-DTPA dynamic imaging GFR. All the eGFRs and rGFR were calculated and standardized by body surface area. Results： The average of rGFR of 195 patients with CKD was（ 72. 26 ± 33. 18） ml·min^-1·1. 73 m^-2. All the equations correlated well with rGFR and the correlation coefficient of MDRD2006 equations was the highest（ r = 0. 736,P〈0. 001）. MDRD2006 equation had the smallest bias（ 4. 66 ml·min^-1·1. 73 m^-2. The P 15 and P 30 accuracy of the MDRD2006 equation was the highest,which was 33. 85% and 54. 36% respectively. The Bland Altman diagram showed that the MDRD2006 equation had the least bias,the highest precision and the smallest 95 % limits of agreement. Conclusion：MDRD2006 leades to more accurateGFR estimation in Chinese patients with CKD. But more larger sample size should be used as evidence-based basis.