不同公式在估算孤立肾人群肾小球滤过率的应用评价研究

Application evaluation of different equations for estimated glomerular filtration rate in the solitary functioning kidney population

目的探讨不同估算孤立肾人群肾小球滤过率公式的评估效能。方法纳入2009年1月~2018年12月在苏州大学附属第二医院行肾动态显象法评估肾功能的258名孤立肾患者,采用偏倚、四分位间距、误分期等指标来衡量9种肾小球滤过率(GFR)评估公式(MDRD、Peking、Macisaac、Steven 1、Steven 2、Steven 3、CKD-EPIScr、CKD-EPIScys C和CKD-EPIScr-Scys C)的准确性和精确性。结果以血清肌酐(Scr)为基础的3个估算公式在总体队列中至少高估参考的肾小球滤过率(rGFR)10 mL/(min·1.73m2),尤其Peking公式精确性和准确性均不佳,偏倚达33.8 mL/(min·1.73m2),3个公式在CKDl-3期均高估估算的肾小球滤过率(eGFR),而在CKD4-5期表现为低估eGFR。以Cys C和血清胱抑素C(Scys C)联合的两种预测公式呈现出较好精确性及一致性。其中,CKD-EPIScr-Scys C公式在总体队列、重度肾功能不全及后天性孤立肾人群中,中位偏倚的绝对值最小,分别是11.1、7.3、11.1 mL/(min·1.73m2);准确性最高,分别是76.7%、85.7%、81.8%,与rGFR比较,P<0.001。结论本研究推荐孤立肾患者在评估肾脏功能时首选CKD-EPIScr-Scys C公式。GFR估算公式的精确性可能与GFR水平和肾功能标志物等因素有关,而与孤立肾分型无关。

Objective To evaluate the efficacy of different equations for estimated glomerular filtration rate in the solitary functioning kidney subjects.Methods A total of 258 patients with solitary functioning kidney who underwent kidney dynamic imaging to evaluate kidney function in the Second Affiliated Hospital of Soochow University from January 2009 to December 2018 were included.The accuracy and precision of 9 glomerular filtration rate(GFR)evaluation equationes(MDRD,Peking,Macisaac,Steven 1,Steven 2,Steven 3,CKD-EPIScr,CKD-EPIScys C and CKD-EPIScr-Scys C)were measured by using the indexes of bias,interquartile interval of difference,and misclassification.Results The three estimation equations based on serum creatinine(Scr)at least overestimated the glomerular filtration rate of reference(rGFR)10 mL/(min·1.73m2)in the whole cohort,especially Peking equation precision and accuracy are poor,the bias is 33.8 mL/(min·1.73m2).All three equations overestimated the estimated glomerular filtration rate(eGFR)at CKDl-3 phase,and underestimated eGFR at CKD4-5 phase.The two prediction equations of combined by Cys C and serum cystatin C(Scys C)showed good accuracy and consistency.The absolute value of median bias of CKD-EPIScr-Scys C equation was the smallest in the overall cohort,severe impaired kidney function,and acquired isolated kidney subjects,which were 11.1,7.3 and 11.1 mL/(min·1.73m2),respectively.And it had the highest accuracy which were 76.7%,85.7%and 81.8%,respectively,and P<0.001 compared with rGFR.Conclusion In this study,CKD-EPIScr-Scys C equation is recommended as the first choice for kidney function evaluation in the solitary functioning kidney subjects.The accuracy of GFR estimation equation may be related to GFR level and kidney function markers,but not to solitary functioning kidney type.