评估6个eGFR公式在青岛地区健康成年人群中的临床适用性

Clinical Applicability Evaluation of Six eGFR Formulas in Healthy Adults in Qingdao

目的探索基于血肌酐和胱抑素C的CKD-EPI方程在青岛地区表面健康成年人群中参考范围的初步调查,进而评估6个估算eGFR的在我市的临床适用性。方法随机选取2018年3月-2019年3月就诊于青岛市市立医院,年龄段18~80岁体检健康成年人968例,男464例,女504例。使用贝克曼5800全自动生化仪分别测定其血肌酐(SCr)值、血胱抑素C(Cys C)值,并应用2个MDRD/CKD-EPI SCr/Cys C联合方程(标为eGFR1、eGFR^(2))、2个中国eGFR协作组CysC方程(标为eGFR3、eGFR4)及近来文献发表的估算公式(标为eGFR5、eGFR6)计算相应的eGFR,评估GFR估算方程在我市健康成年人群中的适用性;根据国际临床化学和检验医学联合会(IFCC)和美国临床实验室标准化协会(CLSI)C28-A3文件的相关要求制定合理的参考区间,以非参数法确定合适eGFR的95%参考区间(百分位数范围为2.5%∼97.5%,可信区间为95%)。结果剔除离群值纳入的965例研究者,男性肌酐(72.68±9.53)μmol/L,女性肌酐(56.19±7.56)μmol/L,胱抑素C(0.90±0.13)mg/L,eGFR非正态分布。不同估算的eGFR公式比较,发现方程5的离散最小(P_(25)-P_(75):90.65-100.39);方程2和方程5较方程1、3、6受男、女性别差异小(P>0.05);6个eGFR均与年龄呈一定负相关,方程5的与年龄的拟合优度最大(R^(2)=0.56)。结论我院宜选择杨渝伟、俸家富等开发研究的方程5作为GFR的估算公式,确定eGFR的95%参考区间:18~38岁(86~129mL/min/1.73m^(2))、39~59岁(74~114mL/min/1.73m^(2))、60~80岁(65~98mL/min/1.73m^(2))。

Objective To explore and investigate reference range of CKD-EPI equation based on serum creatinine and cystatin C in apparently healthy adults in Qingdao,and evaluate clinical applicability of six methods for estimating EGFR in our city.Methods The paper chose 968 healthy adults,464 males and 504 females,aged 18-80 randomly in Qingdao Municipal Hospital from March 2018 to March 2019,and measured values of serum creatinine(SCR)and cystatin C(CysC)by Beckman 5800 automatic biochemical instrument,calculated corresponding EGFR with two MDRD/CKD EPI SCR/Cys C joint equations(labeled eGFR1and eGFR^(2)),two CysC equations of Chinese EGFR cooperation group(labeled eGFR3 and eGFR4)and estimation formulas published in recent literature(labeled eGFR5 and eGFR6),to evaluate applicability of GFR estimation equation in healthy adults in our city.According to relevant requirements of the International Federation of clinical chemistry and laboratory medicine(IFCC)and the American Society for clinical laboratory standardization(CLSI)C28-a3 documents,the paper formulates reasonable reference interval,and determines 95%reference interval of appropriate EGFR by nonparametric method(percentile range is 2.5%~97.5%,and credible interval is 95%).Results Among 965 researchers excluded outliers,male creatinine was(72.68±9.53)μMol/L,female creatinine was(56.19±7.56)μMol/L,Cystatin C was(0.90±0.13)mg/L,EGFR was non normal distribution.Comparing EGFR formulas of different estimates,it was found that dispersion of equation 5 was the smallest(P_(25)-P_(75):90.65-100.39);Equation 2 and equation 5 was less affected by male and female than equations 1,3 and 6(P>0.05);six EGFR was negatively correlated with age,and fit goodness between equation 5 and age was the largest,(R^(2)=0.56).Conclusion It is necessary to choose equation 5 developed by Yang Yuwei and Feng Jiafu of our hospital as GFR estimation formula,and determine 95%reference interval of EGFR:18-38 years old(86-129mL/min/1.73m^(2)),39-59 years old(74-114 mL/min/1.73m^(2)),60-80 years old(65-98 mL/min/1.73m^(2)).