民航飞行(学)员无症状血肌酐升高者肾功能损害情况分析

Correlative analysis of elevated serum creatinine and renal dysfunction in asymptomatic civil pilots(cadets)

目的探讨飞行员单纯血肌酐(serum creatinine, Scr)升高时, 以^(99m)Tc-二乙三胺五乙酸(diethylene triamine pentaacetic acid, DTPA)肾动态显像为标准方法测定肾小球滤过率(glomerular filtration rate, GFR)(以下简称^(99m)Tc-GFR)判断出现肾功能损害的情况;并比较血胱抑素C(cystatin C, Cys C)和GFR评估方程在单纯Scr升高的飞行人员中诊断的准确性。方法以2018—2019年在中国民用航空局民用航空医学中心进行健康体检鉴定、2次Scr检测均增高的飞行员及飞行学员为研究对象。Scr取平均值, 根据Scr值按照Cockcroft-Gault肌肝清除率(Cockcroft-Gault creatinine clearance, CG-CCr)评估方程和肾脏病膳食改良(modification of diet in renal disease, MDRD)公式计算出GFR(以下简称MDRD-GFR), 并进行血Cys C、^(99m)Tc-GFR检查。按检查结果分为^(99m)Tc-GFR正常组(^(99m)Tc-GFR≥90 ml/min)和^(99m)Tc-GFR减低组(^(99m)Tc-GFR<90 ml/min)。结果共入选95例, 均为男性, 平均年龄(35.27±10.32)岁。其中59例(62.1%)GFR减低。Scr、MDRD-GFR、Cys C、CG-CCr与总肾^(99m)Tc-GFR的相关性系数r分别为0.218、0.535、0.808、0.857。在^(99m)Tc-GFR正常组和减低组间, MDRD-GFR、CG-CCr以及Cys C差异有统计学意义(P<0.01)。结论单纯Scr升高者中62.1%出现肾功能损害。除^(99m)Tc-GFR外, 血Cys C以及CG-CCr诊断准确性较高, 可以作为Scr升高者的补充检查。

Objective To evaluate the diagnosis of renal function impairment as the serum creatinine(Scr)level raised in pilots by determining the glomerular filtration rate(GFR)(^(99m)Tc-GFR)through diethylene triamine pentaacetic acid(DTPA)renal dynamic imaging standard method and to compare the accuracy of determining simply elevated Scr between the diagnosing of cystatin C(Cys C)and GFR evaluation for flying personnel.Methods In this study,pilots and pilot cadets whose Scr level was diagnosed raised twice in the physical examinations at Civil Aviation Medical Center of Civil Aviation Administration of China during 2018-2019 were selected as subjects.The GFR was calculated by the evaluation equations of Cockcroft-Gault creatinine clearance(CG-CCr)and the modification of diet in renal disease(MDRD-GFR)upon the averaged Scr level.Blood Cys C and ^(99m)Tc-GFR were examined.According to the examination results,they were divided into ^(99m)Tc-GFR normal group(^(99m)Tc-GFR≥90 ml/min)and ^(99m)Tc-GFR reduced group(^(99m)Tc-GFR<90 ml/min).Results A total of 95 cases were enrolled,all male with an average age of(35.27±10.32)years.There were 59 cases with renal function impairment,accounting for 62.1%.The correlation coefficients r of Scr,MDRD-GFR,Cys C,CG-CCr and total kidney ^(99m)Tc-GFR were 0.218,0.535,0.808,0.857,respectively.There were statistically significant differences in MDRD-GFR,CG-CCr and Cys C between normal and reduced ^(99m)Tc-GFR groups(P<0.01).Conclusion The percentage of renal impairment in simple Scr raised pilots is 62.1%.Besides ^(99m)Tc-GFR,Cys C and CG-CCr have good diagnostic accuracy and can be used as a supplementary examination item for the patients with elevated Scr.