4种常用公式对常驻高原慢性肾脏病官兵肾小球滤过率的准确性评估

Evaluation of the accuracy of four commonly used formulae on glomerular filtration rate in military officers and soldiers who stationed at high altitude with chronic kidney disease

目的:评估常驻高原罹患慢性肾脏病官兵使用肾脏疾病膳食改良研究工作组(The modification of diet in renal disease,MDRD)公式、2009年慢性肾脏病合作组织(Chronic kidney disease epidemiology collaboration,CKD-EPI)3种CKD-EPI公式基于血清肌酐(serum creatinine,Scr)及胱抑素C(serum cystatin C,Scys C)的eGFR估算公式估算肾小球滤过率的准确性。方法:分析2019-01-01~2020-12-31在我院住院治疗的慢性肾脏病官兵(甘肃青海地区常驻海拔>2400 m)的临床资料,以99m Tc-DTPA直接测定为金标准,评估中国改良MDRD公式、CKD-EPI Scr、CKD-EPI Scys C及CKD-EPI Scr-Scys C与99m Tc-DTPA实测GFR的准确性。结果:共收集官兵107例,士官69例(64.5%),军官38例(35.5%)。士官组较军官组年龄小(P<0.05),病程短(P<0.05),但肾功能较差(P<0.05)。在常驻高原官兵中具有最低的偏倚和最高的准确度eGFR公式依次是CKD-EPI Scr-Scys C、CKD-EPI Scys C、CKD-EPI Scr和MDRD公式。CKD-EPI Scr-Scys C和CKD-EPI Scys C公式的准确性高于CKD-EPI Scr和MDRD公式(P<0.05)。CKD-EPI公式与mGFR线性比较总体优于MDRD公式,CKD-EPI Scr-Scys C相关性最好,判定系数R 2为0.796。结论:常驻高原官兵CKD-EPI公式较MDRD公式具有更好的评估准确性。3种CKD-EPI公式中,CKD-EPI Scr-Sys C和CKD-EPI Sys C在评估中准确性最高。

Objective:To assess the accuracy of the glomerular filtration rate estimate formula:the MDRD formula and three types CKD-EPI formulas in officers and soldiers who stationed at high altitude with chronic kidney disease.Methods:Analyze the clinical data of officers and soldiers with chronic kidney disease who were hospitalized(resident at an altitude of 2400m or more in Qinghai,Gansu area),from January 2019 to December 2020,and use the direct determination of 99m Tc-DTPA as the gold standard to evaluate the accuracy of eGFR compare with China improved MDRD formula,CKD-EPI Scr formula,CKD-EPI Scys C formula and CKD-EPI Scr-Scys C formula.Results:A total of 107 military officers and soldiers were collected,including 69 soldiers(64.5%),and 38 military officers(35.5%).The soldiers group was younger(P<0.05)and had a shorter course of disease(P<0.05),but the renal function was worse(P<0.05)than the military officer group.The eGFR formulas with the lowest bias and highest accuracy respectively are the CKD-EPI Scr-Scys C formula,CKD-EPI Scys C formula,CKD-EPI Scr formula and MDRD formula.The accuracy of the CKD-EPI Scr-Scys C and CKD-EPI Scys C formulas is higher than that of the CKD-EPI Scr and MDRD formulas(P<0.05).The linear comparison between CKD-EPI formula and mGFR is generally better than MDRD formula.CKD-EPI Scr-Scys C has the best correlation,and the determination coefficient is 0.796.Conclusion:The CKD-EPI formula has better evaluation accuracy than the MDRD formula for military officers and soldiers who long-term stationed in the plateau.Among the three CKD-EPI formulas,CKD-EPI Scr-Sys C and CKD-EPI Sys C have the highest accurac.