8种肾小球滤过率预测公式对肾细胞癌患者肾功能评价的适用性及相关因素分析

The applicability of estimated glomerular filtration rate prediction equations in patients with renal cell carcinoma and analysis of related factors

目的评价8种常用的肾小球滤过率(GFR)预测公式对肾细胞癌患者肾功能评价的适用性,并分析影响预测公式的相关因素。方法收集蚌埠医学院第一附属医院泌尿外科2017年1月—2018年12月收治的132例肾细胞癌患者的临床资料进行回顾性分析。记录患者术前测得的血清肌酐Scr值、年龄、性别、体质量指数(BMI)、有无合并症、肿瘤T分期等资料。以外源性放射标记物同位素99Tcm-二乙三胺五醋酸(DTPA)的肾排泄率所测得的GFR参照值(rGFR)为标准,应用Bland-Altman分析法比较以下8种预测公式计算得出GFR评估值(eGFR)的偏差:改良MDRD-1、改良MDRD-2,CKD-EPI公式,联合血清肌酐与胱抑素C的公式,Cockcroft-Gault(C-G)公式,基于胱抑素C的公式1,基于胱抑素C的公式2,简化MDRD公式。通过单因素分析方法分别观察患者性别、年龄、BMI、T分期及合并症等对不同预测公式的影响。结果以rGFR为标准比较8种计算公式的95%一致性分析,胱抑素C相关的2种公式均低估了GFR实际水平,其余6种公式均不同程高估了GFR实际水平。eGFR值偏差较小的3种公式依次是CKD-EPI(7.74 mL/min)、血清肌酐与胱抑素C(7.87 mL/min)以及改良MDRD-1公式(7.98 mL/min),界外百分比最低的3种公式依次为改良MDRD-2(1.98%)、改良MDRD-1(2.48%)、C-G公式(2.97%);eGFR值偏差最大的公式为:改良MDRD-2(22.22 mL/min)。通过单因素分析显示8种公式计算的eGFR结果在不同性别、BMI及T分期的肾癌患者间差异均无统计学意义(P值均>0.05)。除胱抑素C-1和胱抑素C-2两种公式计算结果外,其余6种公式计算的eGFR值在不同年龄段结果不同(随年龄的增高均减少),在合并症组较无合并症组低,差异均有统计学意义(P值均<0.05)。结论CKD-EPI、联合肌酐胱抑素以及改良MDRD-1对于评价肾癌患者适用性较好,影响eGFR准确度的因素是多样的,患者年龄和是否存在合并症对预测公式的一致性影响较大。

Objective To evaluate the applicability of several estimated glomerular filtration rate(eGFR)prediction equations in patients with renal cell carcinoma,and analyze the related factors.Methods A total of 132 patients with renal cell carcinoma were collected in the Department of Urology of the First Affiliated Hospital of Bengbu Medical College from January 2017 to December 2018.Serum creatinine,age,sex,body mass index(BMI),complications and T stage were recorded before operation.Base on the standard result by dectecting exogenous radioactive marker technetium-99m diethylenetriamine penta-acetic acid(99mTc-DTPA),the following eight equations were evaluated with Bland-Altman analysis:modified MDRD-1,modified MDRD-2,CKD-EPI equation,combined SCr and cystatin C equation,Cockcroft-Gault(CG)equation,cystatin C-based equation 1,cystatin C-based equation 2 and simplified MDRD equation.And the influencing factors on these eight equations were analyzed by univariate analysis.Results Compared with the 95%consistency analysis of the eight formulas based on rGFR,the two formulas related to cystatin C underestimated the actual level of GFR,and the other six formulas overestimated the actual level of GFR in different ranges.The three formulas with smaller deviation were CKD-EPI(7.74),combined creatinine cystatin(7.87)and modified MDRD-1(7.98).The three formulas with the lowest percentage out of boundaries were improved MDRD-2(1.98%),improved MDRD-1(2.48%)and C-G formulas(2.97%).The formula with the greatest deviation was improved MDRD-2(22.22).The effects of sex,age,BMI,T stage and complications on the predictive formula were analyzed by univariate analysis.The results showed that there was no significant difference in the results of the eight methods in different sex,BMI and T stages of renal cancer patients(all P values>0.05).Except for cystatin C-1 and cystatin C-2,the results of the other six methods were different in different age groups.The eGFR value decreased with the increase of age,and the difference was statistically significant(all P values<0.05).Similar to the results,except for cystatin C-1 and cystatin C-2,the results of the other six calculation methods in the patients with complications were significantly lower than those in the patients without complications,and the difference was statistically significant(all P values<0.05).Conclusions CKD-EPI,creatinine cystatin and modified MDRD-1 are better for evaluating the applicability of renal cancer patients.The factors affecting the accuracy of eGFR are various.The age of patients and the presence of complications have a greater impact on the consistency of the prediction formula.