肾小球率过滤评估公式在儿童ALL高浓度甲氨蝶呤化疗剂量调整中的适用性研究

Applicability of Seven Glomerular Filtration Rate Evaluation Formulas in Dose Adjustment of High Concentration of Methotrexate Chemotherapy in Children with ALL

目的:探讨7种肾小球滤过率(GFR)评估公式Schwartz2009、Schwartz1976、Counahan-Barratt、Filler、CKD-EPIS_(cysC)、Cockrofi-Gault、CKD-EPIS_(cysC-Scr)在儿童急性淋巴细胞白血病(ALL)高浓度甲氨蝶呤(HDMTX)化疗给药剂量调整界点(GFR≤85 ml/min)的诊断效能。方法:纳入124例次儿童ALL患者为研究对象,以肾动态显像法测定的GFR(sGFR)作为标准,评估公式估算GFR(eGFR)与sGFR的准确性、一致性及sGFR≤85 ml/min界点的诊断效能。结果:Schwartz2009公式估算0-3岁组、>4且≤6岁组、>6且≤9岁组、>9且≤16岁组及男性儿童组eGFR值准确性均大于70%,一致性均超出专业界限值;CKD-EPIS_(cysC)公式在0-3岁组、>3且≤4岁组,Filler公式在>3且≤4岁组,Cockrofi-Gault公式在>6且≤9岁组的受试者工作特征曲线(ROC)中sGFR≤85 ml/min的灵敏度为100%时,特异度分别为73.02%、78.95%、78.95%、69.32%,ROC曲线下面积为最大(P<0.05)。结论:7种肾小球滤过率评估公式中Schwartz2009公式预测eGFR的准确性最高,CKD-EPIS_(cysC)、Filler、Cockrofi-Gault公式对儿童ALL青春期前sGFR≤85 ml/min HDMTX化疗剂量调整更具指导意义。

Objective: To investigate the diagnostic efficacy of seven glomerular filtration rate(GFR) evaluation formulas Schwartz2009, Schwartz1976, Counahan-Barratt, Filler, CKD-EPIS_(cysC), Cockrofi-Gault, CKD-EPIS_(cysC-Scr)in high concentration of methotrexate(HDMTX) chemotherapy dose adjusted cut-off point(GFR ≤85 ml/min) in children with acute lymphoblastic leukemia(ALL). Methods: One hundred and twenty-four children with ALL were included in the study. GFR determined by renal dynamic imaging(sGFR) was used as the standard to evaluate the accuracy, consistency of eGFR calculated by seven formulas and sGFR, and the diagnostic efficacy of each formula when the sGFR ≤85 ml/min boundary. Results: All of the accuracy of eGFR estimated by Schwartz2009 were greater than 70% in the 0-3, >4 and ≤6, >6 and ≤9, >9 and ≤16 years old group and male group, and the consistency exceeded the professional threshold. When the sensitivity of the ROC curve sGFR ≤85 ml/min was 100% of CKD-EPIS_(cysC)in the 0-3, >3 and ≤4 years old group, Filler in the >3 and ≤4 years old group, and Cockrofi-Gault in the >6 and ≤9 years old group, the specificity was 73.02%, 78.95%, 78.95%, 69.32%, respectively, and the AUC under the ROC curve was the largest(P<0.05). Conclusion: Schwartz2009 formula predicts the highest accuracy of eGFR in the 7 glomerular filtration rate. CKD-EPIS_(cysC), Filler, and Cockrofi-Gault formulas have more guiding signi-ficance for the adjustment of HDMTX chemotherapy in pre-adolescence in children with ALL when sGFR ≤85 ml/min.