不同肾小球滤过率计算公式在高血压患者肾功能分期中的价值

Value of different glomerular filtration rate calculation formulas in renal function staging of hypertensive patients

目的评价基于血清肌酐[肾脏疾病膳食改良(MDRD)简化公式、Cockcroft-Gault公式和CKD-EPI公式]及胱抑素C计算的肾小球滤过率(GFR)在高血压患者中进行肾功能分级的作用。方法选取2018年1月1日至2021年9月30日于福建省老年医院住院且进行^(99m)Tc-DTPA肾动态显像、胱抑素C及血肌酐等检测的148例高血压患者作为研究对象,根据^(99m)Tc-DTPA肾动态显像检测的GFR_(核素)结果将患者肾功能分为5级,根据胱抑素C及血肌酐计算推测GFR(GFR_(胱抑素C)、GFR_(MDRD)、GFR_(C-G)及GFR_(CKD-EPI))。结果^(99m)Tc-DTPA肾动态显像结果显示,111例(75%)高血压患者合并肾功能损害。不同计算公式的灵敏度及特异性:GFR_(胱抑素C)灵敏度为70.27%,特异性为84.68%;GFR_(MDRD)灵敏度为73.00%,特异性为87.39%;GFR_(C-G)灵敏度为70.27%,特异性为90.00%;GFR_(CKD-EP)灵敏度为78.38%,特异性为86.49%。Pearson相关分析显示,不同公式计算的GFR值之间及其与GFR_(核素)呈正相关,与胱抑素C、血肌酐呈负相关(P<0.01)。一致性检验Kappa系数分别为GFR_(胱抑素C)=0.372,GFR_(MDRD)=0.356,GFR_(C-G)=0.396,GFR_(CKD-EPI)=0.408(P<0.01)。四个计算公式总体正确分级率和受试者工作特征(ROC)曲线下面积比较,差异无统计学意义(P>0.05)。结论基于血清肌酐(MDRD简化公式、Cockcroft-Gault公式和CKD-EPI公式)及胱抑素C计算的肾小球滤过率是评价高血压患者肾功能的敏感和可靠的指标,分级准确率相似。

Objective To evaluate the role of glomerular filtration rate(GFR)calculated based on serum creatinine(the modification of diet in renal disease[MDRD]simplified formula,Cockcroft-Gault formula and CKD-EPI formula)and cystatin C in grading renal function in hypertensive patients.Methods A total of 148 patients with hypertension who were hospitalized in Fujian Geriatric Hospital from January 1,2018 to September 30,2021 and underwent ^(99m)Tc-DTPA renal dynamic imaging,cystatin C and serum creatinine detection were selected as the study objects.According to the GFR_(nuclide) results of ^(99m)Tc-DTPA renal dynamic imaging,renal function of the patients was divided into 5 grades.GFR(GFR_(cystatin C),GFR_(MDRD),GFR_(C-G) and GFR_(CKD-EPI))were estimated by cystatin C and serum creatinine calculations.Results ^(99m)Tc-DTPA renal dynamic imaging showed that 111 patients(75%)with hypertension were complicated with renal impairment.The sensitivity and specificity of different formulas were as follows:the sensitivity and specificity of GFR_(cystatin C) were 70.27%and 84.68%respectively.The sensitivity and specificity of GFR_(MDRD) were 73.00%and 87.39%respectively.The sensitivity and specificity of GFR_(C-G) were 70.27%and 90.00%respectively.The sensitivity and specificity of GFR_(CKD-EPI) were 78.38%and 86.49%respectively.Pearson correlation analysis showed that GFR values calculated by different formulas were positively correlated with GFR_(nuclide),but negatively correlated with cystatin C and serum creatinine(P<0.01).The Kappa coefficients of consistency test were GFR_(cystatin C)=0.372,GFR_(MDRD)=0.356,GFR_(C-G)=0.396,GFR_(CKD-EPI)=0.408(P<0.01).There were no significant differences in the overall correct classification rate and the area under receiver operating characteristic(ROC)curve of the four formulas(P>0.05).Conclusion GFR calculated based on serum creatinine(MDRD simplified formula,Cockcroft-Gault formula and CKD-EPI formula)and cystatin C is a sensitive and reliable indicator to evaluate renal function in hypertensive patients,with similar grading accuracy.