不同肾小球滤过率评估公式在2型糖尿病患者中的适用性

Application of different glomerular filtration rate assessment formulas in type 2 diabetic patients

目的:比较不同肾小球滤过率(GFR)评估公式对2型糖尿病(T2DM)患者肾功能的诊断价值。方法:回顾性分析322例T2DM患者的资料,以24小时肌酐清除率计算得到的GFR为标准肾小球滤过率(rGFR),以C-G公式、简化MDRD公式、改良的MDRD中国公式和CKD-EPI公式计算得到的GFR为估算的肾小球滤过率(e GFR),比较各e GFR的准确度、精确度和偏差、ROCAUC,并根据不同年龄、糖化血红蛋白分层分析。结果:CKD-EPI公式估算的GFR与r GFR的相关系数最高(r=0.788)。CKD-EPI公式的15%准确度(P15)、30%准确度(P30)最高,分别为48.1%、73.6%。Bland-Altman图显示简化MDRD公式的偏差最小,CKD-EPI公式精确度最高。MDRDC公式、CKD-EPI公式诊断慢性肾功能不全的ROCAUC相等且最大。年龄≥60岁组和18~60岁组中均以CKD-EPI公式的P30、P50最高,精确度最好。CKD-EPI公式在不同糖化血红蛋白组精确度均最好,准确度均最高。结论:CKD-EPI公式更适合于估测我国T2DM患者的GFR,同时在不同年龄、糖化血红蛋白下均最适用。

Objective:To evaluate the different glomerular filtration rate assessment formulas in type 2 diabetic patients.Methods:The data of 322 patients with type 2 diabetes mellitus were analyzed retrospectively,the glomerular filtration rate calculated by 24-hour creatine clearance rate was rGFR,eGFR was calculated by C-G formula,simplified MDRD formula,and the improved MDRD China formula and CKD-EPI formula,to compare the accuracy,accuracy,deviation,ROCAUC of each eGFR,and hierarchical analysis at different ages and glycosylated hemoglobin.Results:The correlation coefficient between GFR estimated by CKD-EPI formula and rGFR was the highest,r=0.788.The P15 and P30 of CKD-EPI formula were the highest,which are 48.1%and 73.6%,respectively.Bland-Altman diagram showed minimum deviation between simplified MDRD formula and rGFR,CKD-EPI formula had the highest accuracy.The area under ROC curve of MDRDC formula and CKDEPI formula in the diagnosis of chronic renal insufficiency was equal and the largest.In the group of age≥60 years old and the group of 18<age<60 years old,the correlation of CKD-EPI formula was the best,P30 and P50 were the highest,and the highest accuracy.CKD-EPI formula had the best P30 and P50,the highest accuracy in different glycosylated hemoglobin.Conclusion:The CKD-EPI formula was most suitable for the estimation of GFR in Chinese patients with type 2 diabetes mellitus at the same time under different ages and glycosylated hemoglobin.