Kidney function outcomes following thermal ablation of small renal masses

The diagnosis of small renal masses(SRMs) continues to increase likely attributable to widespread use of axial cross-sectional imaging. Many of these SRMs present in elderly patients with abnormal baseline renal function. Such patients are at risk for further decline following therapeutic intervention. Renal thermal ablation presents one approach for management of SRMs whereby tumors are treated in situ without need for global renal ischemia. These treatment characteristics contribute to favorable renal function outcomes following kidney tumor ablation particularly in patients with an anatomic or functional solitary renal unit.

Renal function in diabetic nephropathy

Diabetic nephropathy is the kidney disease that occurs as a result of diabetes.Cardiovascular and renal complications share common risk factors such as blood pressure,blood lipids,and glycemic control.Thus,chronic kidney disease may predict cardiovascular disease in the general population.The impact of diabetes on renal impairment changes with increasing age.Serum markers of glomerular filtration rate and microalbuminuria identify renal impairment in different segments of the diabetic population,indicating that serum markers as well as microalbuminuria tests should be used in screening for nephropathy in diabetic older people.The American Diabetes Association and the National Institutes of Health recommend Estimated glomerular filtration rate(eGFR) calculated from serum creatinine at least once a year in all people with diabetes for detection of kidney dysfunction.eGFR remains an independent and significant predictor after adjustment for conventional risk factors including age,sex,duration of diabetes,smoking,obesity,blood pressure,and glycemic and lipid control,as well as presence of diabetic retinopathy.Cystatin-C(Cys C) may in future be the preferred marker of diabetic nephropathy due differences in measurements of serum creatinine by various methods.The appropriate reference limit for Cys C in geriatric clinical practice must be defined by further research.Various studies have shown the importance of measurement of albuminuria,eGFR,serum creatinine and hemoglobin level to further enhance the prediction of end stage renal disease.

Difference between CKD-EPI and MDRD equations in calculating glomerular filtration rate in patients with cirrhosis

AIM:To evaluate the difference between the performance of the (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations in cirrhotic patients. METHODS: From Jan 2004 to Oct 2008, 4127 cirrhotic patients were reviewed. Patients with incomplete data with respect to renal function were excluded; thus, a total of 3791 patients were included in the study. The glomerular filtration rate (GFR) was estimated by the 4-variable MDRD (MDRD-4), 6-variable MDRD (MDRD-6), and CKD-EPI equations.RESULTS:When serum creatinine was 0.7-6.8 mg/dL and 0.6-5.3 mg/dL in men and women, respectively, a significantly lower GFR was estimated by the MDRD-6 than by the CKD-EPI. Similar GFRs were calculated by both equations when creatinine was > 6.9 mg/dL and > 5.4 mg/dL in men and women, respectively. In predicting in-hospital mortality, estimated GFR obtained by the MDRD-6 showed better accuracy [81.72%; 95% confidence interval (CI), 0.94-0.95] than that obtained by the MDRD-4 (80.22%; 95%CI, 0.96-0.97), CKD-EPI (79.93%; 95%CI, 0.96-0.96), and creatinine (77.50%; 95%CI, 2.27-2.63). CONCLUSION: GFR calculated by the 6-variable MDRD equation may be closer to the true GFR than that calculated by the CKD-EPI equation.

Relative performance of two equations for estimation of glomerular filtration rate in a Chinese population having chronic kidney disease

Background The new Chronic Kidney Disease Epidemiology Collaboration （CKD-EPI） equation was developed to address the systematic underestimation of glomerular filtration rate （GFR） by the Modification of Diet in Renal Disease （MDRD） Study equation in patients with relatively well-preserved kidney function.Performance of the new equation in the Chinese population is unknown.The goal of the present study was to compare performance of these two equations in Chinese patients with chronic kidney disease （CKD）.Methods We enrolled 450 Chinese patients （239 women and 211 men） with CKD in the present study.The renal dynamic imaging method was used to measure the referenced standard GFR （rGFR） for comparison with estimations using the two equations.Their overall performance was assessed with the Bland-Altman method and receiver-operating characteristics （ROC） analysis.Performance of the two equations in lower and higher estimated GFR （eGFR） subgroups was further investigated.Results Both eGFRs correlated well with rGFR （r=0.88,0.81,P〈0.05）.In overall performance,the CKD-EPI equation showed less bias,higher precision and improved accuracy,and was better for detecting CKD.In the higher-eGFR subgroup,the CKD-EPI equation corrected the underestimation of GFR by the abbreviated MDRD equation.Conclusions The CKD-EPI equation outperformed the abbreviated MDRD equation not only in overall performance but also in the subgroups studied.For the present,the CKD-EPI equation appears to be the first-choice prediction equation for estimating GFR.

Cockcroft-Gault公式和中国人MDRD公式在红斑狼疮患者肾小球滤过率的评估

目的探讨Cockcroft-Gault公式(CG公式)以及中国人MDRD公式(c-MDRD)在狼疮(SLE)患者肾小球滤过率(GFR)评估中的作用。方法本研究纳入193名SLE患者。测量肾小球滤过率(mGFR)、血清肌酐(SCr),根据cMDRD公式,以及C-G公式分别得出估算肾小球滤过率(eGFR)。从不同方面对eGFR进行评估。结果 193名患者中,mGFR中位值为75.01 mL/(min·1.73 m^2),eGFR-CG中位值70.22 mL/(min·1.73m^2),eGFR-c-MDRD中位值70.67 mL/(min·1.73 m^2)。患者分为mGFR≥60/(n=108)和mGFR<60 mL/(min·1.73 m^2)(n=85)。对于总体病人而言,CG和c-MDRD偏差值分别为0.64和3.91 mL/(min·1.73 m^2)。在精确度以及准确度上,CG均优于c-MDRD。除了mGFR<60 mL/(min·1.73 m^2)组中CG偏差值稍高于c-MDRD外,CG在分组后的表现仍然优于c-MDRD。结论和中国人MDRD公式相比,CG公式更加适合用在SLE的GFR评估。

Analysis of chronic kidney disease staging with different estimated glomerular filtration rate equations in Chinese centenarians

Background: Accurate estimation of the glomerular filtration rate (GFR) and staging of chronic kidney disease (CKD) are important. Currently, there is no research on the differences in several estimated GFR equations for staging CKD in a large sample of centenarians. Thus, this study aimed to investigate the differences in CKD staging with the most commonly used equations and to analyze sources of discrepancy. Methods: A total of 966 centenarians were enrolled in this study from June 2014 to December 2016 in Hainan province, China. The GFR with the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Berlin Initiative Study 1 (BIS1) equations were estimated. Agreement between these equations was investigated with the k statistic and Bland-Altman plots. Sources of discrepancy were investigated by partial correlation analysis. Results: The k values of the MDRD and CKD-EPI equations, MDRD and BIS1 equations, and CKD-EPI and BIS1 equations were 0.610, 0.253, and 0.381, respectively. Serum creatinine (Scr) explained 10.96%, 41.60% and 17.06% of the variability in these three comparisons, respectively. Serum uric acid (SUA) explained 3.65% and 5.43% of the variability in the first 2 comparisons, respectively. Gender was associated with significant differences in these 3 comparisons (P<0.001). Conclusions: The strengths of agreement between the MDRD and CKD-EPI equations were substantial, but those between the MDRD and BIS 1 equations and the CKD-EPI and BIS 1 equations were fair. The difference in CKD staging of the first 2 comparisons strongly depended on Scr, SUA and gender, and that of CKD-EPI and BIS1 equations strongly depended on Scr and gender. The incidence at various stages of CKD staging was quite different. Thus, a new equation that is more suitable for the elderly needs to be built in the future.

估计的 glomerular 过滤率比要合并到结束阶段肝疾病分数的 creatinine 好吗？

AIM: To incorporate estimated glomerular filtrationrate (eGFR) into the model for end-stage liver disease(MELD) score to evaluate the predictive value.METHODS: From January 2004 to October 2008,the records of 4127 admitted cirrhotic patients were reviewed. Patients who survived and were followed up as outpatients were defined as survivors and theirmost recent available laboratory data were collected.Patients whose records indicated death at any time during the hospital stay were defined as non-survivors(in-hospital mortality). Patients with incomplete dataor with cirrhosis due to a congenital abnormality suchas primary biliary cirrhosis were excluded; thus, a totalof 3857 patients were enrolled in the present study.The eGFR, which was calculated by using either the modification of diet in renal disease (MDRD) equationor the chronic kidney disease epidemiology collaboration (CKD-EPI) equation, was incorporated into the MELD score after adjustment with the original MELDequation by logistic regression analysis [bilirubin and international normalized ratio (INR) were set at 1.0 forvalues less than 1.0].RESULTS: Patients defined as survivors were significantly younger, had a lower incidence of hepatoma,lower Child-Pugh and MELD scores, and better renalfunction. The underlying causes of cirrhosis werevery different from those in Western countries. In Tai-wan, most cirrhotic patients were associated with thehepatitis virus, especially hepatitis B. There were 16parameters included in univariate logistic regressionanalysis to predict in-hospital mortality and those with significant predicting values were included in furthermultivariate analysis. Both 4-variable MDRD eGFR and6-variable MDRD eGFR, rather than creatinine, weresignificant predictors of in-hospital mortality. Threenew equations were constructed (MELD-MDRD-4,MELD-MDRD-6, MELD-CKD-EPI). As expected, originalMELD score was a significant predictor of in-hospitalmortality (odds ratio = 1.25, P 【 0.001). MELD-MDRD-4 excluded serum creatinine, with the coeffi-cients refit among the remaining 3 variables, i.e., totalbilirubin, INR and 4-variable MDRD eGFR. This model represented an exacerbated outcome over MELD score,as suggested by a decrease in chi-square (2161.45 vs2198.32) and an increase in -2 log (likelihood) (2810.77vs 2773.90). MELD-MDRD-6 included 6-variable MDRDeGFR as one of the variables and showed an improvement over MELD score, as suggested by an increasein chi-square (2293.82 vs 2198.32) and a decrease in-2 log (likelihood) (2810.77 vs 2664.79). Finally, whenserum creatinine was replaced by CKD-EPI eGFR, itshowed a slight improvement compared to the originalMELD score (chisquare: 2199.16, -2 log (likelihood): 2773.07). In the receiver-operating characteristic curve, the MELD-MDRD-6 score showed a marginal improvement in area under the curve (0.909 vs 0.902), sensitivity (0.854 vs 0.819) and specificity (0.818 vs 0.839) compared to the original MELD equation. In patients with a different eGFR, the MELD-MDRD-6 equation showed a better predictive value in patients with eGFR ≥ 90, 60-89, 30-59 and 15-29.CONCLUSION: Incorporating eGFR obtained by the 6-variable MDRD equation into the MELD score showed an equal predictive performance in in-hospital mortality compared to a creatinine-based MELD score.

血清视黄醇结合蛋白对评价早期肾损伤的诊断价值

目的探讨血清视黄醇结合蛋白(RBP)对早期肾损伤的诊断价值。方法采用免疫比浊法检测343例肾病患者及200例健康人血清RBP的变化。用酶法检测其血清肌酐(Cr)的变化,并由简化MDRD公式计算出估计的肾小球滤过率(GFR)。结果肾功正常组RBP的结果与对照组比较,差异有统计学意义(P<0.05),且RBP在四组中的任意两组之间比较都差异有统计学意义(P<0.05),而血清Cr在正常健康组、肾功正常组和肾功轻度受损组之间差异无统计学意义(P>0.05)。结论 RBP可作为诊断肾病早期损害的敏感性指标,同时检测血清Cr有助于提高其阳性率,但血RBP的敏感性优于血清Cr。

利用肾脏病饮食改良(MDRD)简化公式估算住院患者的肾功能状况

目的:探讨利用血清肌酐(SCr)、年龄、性别估算成年住院患者肾小球滤过率(GFR)在肾功能评价中的价值。方法:收集2006年8月～11月间在中日友好医院住院患者的临床检验结果和人口学数据,包括SCr、年龄、性别。利用2005年修订的肾脏病饮食改良研究简化公式,估算成年住院患者的GFR,并根据美国国家肾脏基金会推荐的慢性肾脏病分期标准统计这些患者的肾功能状况。结果:2006年8月～11月,共7750例成年住院患者在院期间完成了至少1次的SCr测定,39.4%的患者存在肾功能不全情况(GFR<90ml/min),男性和女性情况类似。31.7%的患者存在隐匿性肾功能不全(SCr≤106μmol/L,GFR<90ml/min)。结论:住院患者存在慢性肾功能不全和隐匿性肾功能不全的情况很普遍,检验科在测定SCr的同时报告GFR估算值,有利于医生评价患者的肾功能状况。检验科应充分利用医院信息系统,尽早实施这一附加服务。

简化肾脏病膳食改善方程在慢性肾脏病诊断及治疗中的应用

目的通过检测患者肾小球滤过率(GFR)了解住院患者的肾功能及肾脏损害程度。应用简化肾脏病膳食改善(MDRD)方程估算GFR,为临床选择药物及用药量提供更可靠的依据。方法通过统计8 940例住院成年患者的基本信息,按照性别、年龄、疾病的不同类型及血肌酐水平进行分组。利用MDRD方程估算出患者的GFR。肾损害程度分期采用美国肾病学会(NKF)2002年的慢性肾脏病(CKD)分期。结果8 940例患者中,40.1%的患者存在肾功能不全(GFR<90 mL/min),32.1%的患者存在隐匿性肾功能不全(血肌酐<106μmol/L,GFR<90 mL/min)。506例体检者中有15.2%存在隐匿性肾功能不全。结论由于住院患者多数存在肾功能受损情况,院外部分人群存在隐匿性肾功能不全的隐患,因此应用MDRD方程能更准确地估算GFR值,有利于临床医生在治疗中采用不同的治疗方案。

简化肾脏病膳食改良试验公式在血清肌酐值正常的老年男性群体中的应用

目的:探讨血清肌酐(SCr)正常的老年男性人群SCr值与经肾脏病膳食改良试验(MDRD)公式估算的肾小球滤过率(GFR)的关系。方法:应用简化MDRD公式估算818名门诊体检、SCr正常的老年男性的GFR,将其按估算GFR值[GFR<60mL/(min·1.73m2)、60～89mL/(min·1.73m2)、≥90mL/(min·1.73m2)]进行分组,比较各组间年龄、体重、体重指数(BMI)、腰臀比(WHR)等,结果发现年龄、伴随疾病在不同GFR估算值组中的差异有统计学意义;再将体检者按年龄、伴随疾病分组,并应用线性回归及ROC曲线分析SCr值与GFR估算值的关系。结果:应用简化MDRD公式估算GFR发现,818名体检者中有53人(6.5%)GFR呈中度下降,均值为(57±2)mL/(min·1.73m2),他们平均年龄较大,为(79±6)岁,SCr值较高,为(112±6)μmol/L。按年龄分组中,SCr水平在60～69岁组与70岁以上组比较,差异有统计学意义(P<0.05);按伴随疾病及年龄分组,≥70岁的人群伴高血压合并2型糖尿病的患病率达39.2%,而60～69岁的人群则为15.0%。在无高血压、糖尿病高危因素的人群中,SCr值为109.5μmol/L时,经ROC曲线计算,诊断GFR异常的灵敏度为100%,误诊率为3.1%;合并高危因素人群(年龄≥70岁同时合并2型糖尿病、高血压),SCr值为108.5μmol/L时,诊断GFR异常的灵敏度为100%,误诊率为3.2%。结论:年龄≥70岁合并慢性肾脏疾病(CKD)高危因素(如高血压、2型糖尿病)的老年男性人群,当SCr值为正常高值时(108.5μmol/L),采用MDRD公式估算的GFR可能有异常,本研究方法可用于早期筛查CKD患者。

常用肾功能指标对老年人肾小球滤过率判断的应用价值

目的了解常用肾功能指标判断肾小球滤过率(GFR)的价值。方法老年患者105例,分为肾病组、非肾病1组(年龄<80岁)、非肾病2组(年龄≥80岁),测血清尿素氮(BUN)、血清肌酐(SCr)、血清半胱氨酸蛋白酶抑制剂C(Cys-C),计算MDRD方程,各指标作相关分析与回归分析,组内异常率比较。结果非肾病组BUN、SCr异常率(18.57%、12.86%)与Cys-C异常率(1.43%)比较,差异有统计学意义(P<0.001,P<0.01);肾病组BUN、SCr异常率(60.00%、65.71%)与Cys-C异常率(54.29%)比较,差异无统计学意义(P>0.05)。全部患者Cys-C与年龄、简化MDRD方程(eGFRa)、中国改良MDRD方程7(C-eGFR7)、中国改良简化MDRD方程(C-eGFRa)相关,相关系数(r)分别为0.414、-0.677、-0.736、-0.677,有统计学意义(P<0.001);与改良MDRD方程7(eGFR7)r=-0.258,有统计学意义(P<0.05)。结论Cys-C特异性高于BUN、SCr,能够更准确反映老年患者GFR;C-eGFR7、C-eGFRa准确性高于eGFR7、eGFRa。

糖代谢异常患者肾功能状态对冠脉病变程度的影响

目的探讨糖代谢异常人群中估算的肾小球滤过率（eGFR）对冠脉病变范围及严重程度的影响。方法采用简化的肾脏疾病饮食改良公式（MDRD）计算eGFR，比较不同MDRD-eGFR组在临床生化指标、狭窄冠状动脉支数、冠状动脉狭窄严重程度积分等方面的差别。结果糖调节受损组、糖尿病组及总体人群中，狭窄冠脉支数、Gensini积分与MDRD—eGFR均呈负相关性（P〈0．05），与肌酐均呈正相关性（P〈0．05）。MDRD-eGFR〈60mL·mm-1·（1．73m2）-1 组狭窄冠脉支数多于60～89mL·min-1·（1．73m2）-1组及≥90mL·min。-1·（1．73m2）-1组，Gemini积分也高于其余两组（均P〈0．05）。校正年龄、空腹血糖、糖化血红蛋白、尿素氮、肌酐及尿酸因素后，狭窄冠脉支数、Gensini积分与MDRD—eGFR之间均呈负相关性，偏相关系数分别为-0．051和-0．022（P〈0．05）。Logistic逐步回归分析显示MDRD—eGFR为发生3支及以上冠脉病变的独立危险因素。结论糖代谢异常人群具有较高的冠心病患病率，肾小球滤过率的下降与冠脉病变程度具有一定的负相关性，且为发生多支冠脉病变（≥3支）的独立危险因素。

肌酐-胱抑素C公式在糖尿病肾病超滤过检出中的作用

目的比较MDRD公式、胱抑素C公式及肌酐-胱抑素C公式在中国糖尿病患者中的表现,尤其是在高滤过检出中的作用。方法选取笔者医院2155名糖尿病患者,以99mTc-DTPA GFR为金标准,比较MDRD公式、胱抑素C公式及肌酐-胱抑素C公式在估测GFR方面的优劣。观测指标包括偏倚、精确性及准确性,并对各公式检测结果与金标准进行相关性及线性分析。采用ROC曲线评估各公式对肾功能不全及高滤过的诊断效能。结果 MDRD、胱抑素C及肌酐-胱抑素C公式在总体人群中的绝对偏倚分别为18.98、28.74、18.04,肌酐-胱抑素C公式的偏倚显著低于其他公式(P<0.05),精确度最好(P<0.01)。与MDRD及胱抑素C公式相比,肌酐-胱抑素C公式的15%及50%准确性更高(P<0.05),ROC曲线显示,肌酐-胱抑素C公式能够更加准确的筛选超滤过患者(AUC=0.862,P<0.05)。结论肌酐-胱抑素C公式在中国糖尿病人群中的适用性优于MDRD及胱抑素C公式,肌酐-胱抑素C公式可用于筛选超滤过的糖尿病早期肾损伤的患者。

三种常用公式对糖尿病肾病合并高血压患者肾小球滤过率估算的准确性比较

目的比较慢性肾脏病流行病学协作组(CKD-EPI)开发方程(CKD-EPIcr和CKD-EPIcys)和肾脏病膳食改良(MDRD)简化公式对糖尿病肾病(DN)合并高血压患者肾小球滤过率(GFR)估算的准确性。方法收集2015年1月至2017年12月在山西医科大学附属人民医院确诊为DN,已行肾动态显像检查的89例住院患者的临床资料。按是否合并高血压分为DN不合并高血压组(24例)和DN合并高血压组(65例),每组按年龄分为2个亚组(≥60岁和18～59岁)。分别以CKD-EPIcr、CKD-EPIcys、简化MDRD估算其GFR(eGFR)值,分析该人群中不同eGFR公式的诊断准确性。结果以肾动态显像结果为参考标准,≥60岁亚组DN患者不论是否合并高血压,其CKD-EPIcr、CKD-EPIcys、简化MDRD各公式计算eGFR值准确性一致,与标准值差异无统计学意义(P> 0. 05)。18～59岁亚组DN患者DN不合并高血压组,CKD-EPIcys公式计算eGFR值较CKD-EPIcr、简化MDRD公式更为准确(P> 0. 05);相反,DN合并高血压组,CKD-EPIcr、简化MDRD公式计算eGFR值较CKD-EPIcys公式更准确(P> 0. 05)。≥60岁亚组不论是否合并高血压,肾图及各公式计算eGFR结果组间差异无统计学意义(P=0. 347、0. 977)。18～59岁亚组不论是否合并高血压,肾图及各公式计算eGFR结果组间比较差异均有统计学意义(均P <0. 005)。结论 60岁及以上人群中,是否合并高血压对各估算公式影响不大。60岁以下人群中,DN不合并高血压者,CKD-EPIcys公式估算eGFR值更为准确; DN合并高血压者,简化MDRD、CKD-EPIcr公式估算准确性更高。

Association between serum uric acid and different states of glucose metabolism and glomerular filtration rate

Background Recently, it has been suggested that the serum uric acid （SUA） level decreased in diabetic patients. The aim of this study was to explore the association between SUA level and different state of glucose metabolism and glomerular filtration rate （GFR） reflected by the simplified Modification of Diet in Renal Disease （MDRD） equation and to test the hypothesis that high MDRD is one of the determinants of SUA level.Methods This cross-sectional study included 2373 subjects in Beijing who underwent a 75 g oral glucose tolerance test （OGTT） for screening of diabetes. According to the states of glucose metabolism, they were divided into normal glucose tolerance, impaired glucose regulation and diabetes.Results Multiple stepwise linear regression analysis showed that adjusted by gender, SUA was positively correlated with body mass index （BMI）, waist/hippo ratio, systolic blood pressure （SBP） and triglyceride, meanwhile negatively correlated with age, hemoglobin A1c, fasting insulin and MDRD. There was an increasing trend in SUA concentration and a decreasing trend in MDRD when the levels of fasting plasma glucose （FPG） increased from low to high up to the FPG level of 8.0 mmol/L; thereafter, the SUA concentration started to decrease with further increases in FPG levels, and the MDRD started to increase with further increases in FPG levels.Conclusion This study confirmed the previous finding that SUA decreased in diabetes and provided the supporting evidence that the increased MDRD might contribute to the fall of SUA.

CKD—EPI方程对基于简化MDRD方程的慢性肾脏病患者分期的影响

目的研究CKD．EPI方程对基于简化MDRD方程的慢性肾脏病（CKD）患者分期的影响。方法选择2008年6月至2009年9月在我院。肾内科就诊的CKD患者450例，分别用简化MDRD方程和CKD—EPI方程估测GFR（eGFR）。用Bland—Altman曲线对二方程计算的eGFR进行一致性检验。根据eGFR对CKD患者分期，对基于不同方程的CKD患者的分期情况进行Kappa检验。结果简化MDRD方程和CKD—EPI方程估测eGFR的一致性好，但CKD—EPI—eGFR较MDRD—eGFR平均高出约2．4m1·（min）-1·（1．73m。）。简化MDRD方程和CKD—EPI方程在CKDl、2、3A、3B、4和5期符合率分别为97．10％（n=67），80．77％（n=105），60．86％（n=48），87．69％（n=57），90．38％（n=47）和98．18％（n=54）。Kappa检验提示2方程对CKD患者分期的一致性极好[Kappa值0．913（95％CI：0．881 ～0．945）]。然而，若依据CKD—EPI方程结果，仍须将由简化MDRD方程分类至60。89m1．（min）-1·（1．73㎡）-1及45～59ml·（min）-1·（1．73㎡）-1两组中的19．23％（n=25）及39．24％（n=31）的患者进行再次分类，且均被归为更高eGFR等级。结论CKD—EPI方程可“上调”基于简化MDRD方程的CKD2期～3A期患者的分期等级，纠正了简化MDRD方程对CKD的过度诊断。

三种肾小球滤过率检测方法与^(99m)Tc-DTPA清除率的比较与分析

目的为临床准确评估肾小球滤过率(GFR)提供一定依据。方法对101例各种慢性肾脏病患者,外周静脉注射非离子型造影剂碘海醇(iohexol)5ml,4h后取血2ml,用高效液相色谱(HPLC)法检测血浆iohexol浓度,运用数字模型计算血浆iohexol清除率(iohexol-GFR)。同步检测scr及99mTc-DTPA清除率(99mTc-GFR)。应用Cockcroft-Gault(CG)、肾脏病膳食改良试验(MDRD)公式计算Ccr.GFR。以99mTc-GFR为标准,运用相关回归分析及受试者工作曲线(ROC)对上述指标进行比较。结果慢性肾脏病第1期至第5期,iohexol-GFR与99mTc-GFR相关系数r分别为0.87、0.89、0.88、0.86、0.87(P均<0.01);iohexol-GFR在ROC曲线下面积平均为0.97。MDRD-GFR与99mTc-GFR相关系数r分别为0.80、0.75、0.71、0.67、0.56(P均<0.01),MDRD-GFR在ROC曲线下面积平均为0.82。CG-Ccr与99mTc-GFR相关系数r分别为0.76、0.67、0.62、0.60、0.53(P均<0.05),CG-Ccr在ROC曲线下面积平均为0.82。结论iohexol-GFR检测GFR的准确性优于MDRD-GFR、CG-Ccr,值得推广应用。在无检测条件的情况下,CG、MDRD公式不失为衡量GFR的良好指标。

肾动态显像法与MDRD改良方程法在慢性肾脏病患者分期中的价值比较

目的 评价、比较肾动态显像法与肾脏病膳食改良试验（MDRD）改良方程法两种方法在慢性肾脏病（CKD）患者分期中的准确率,确定临床实践中首选的分期方法.方法 对169例CKD患者同时采用双血浆法、肾动态显像法与MDRD改良方程法测定肾小球滤过率（GFR）,以双血浆法测定的GFR作为“金标准”对患者进行分期,统计分析肾动态显像法与MDRD改良方程法在CKD患者分期中的准确率,并根据分期比较两种方法在各期中的准确率.结果 在纳入的共169例CKD患者中,肾动态显像法分期的准确率为56.80％,MDRD改良方程法的准确率为68.64％,二者的差异有统计学意义（P=0.019＜0.05）.根据分期对各期准确率的比较发现,两种方法仅对肾衰竭期患者的分期准确率差异有统计学意义（P=0.012＜0.05）,而对其他各期患者的分期准确率差异均无统计学意义（P分别为0.180、0.424、0.629和0.754,均＞0.05）.结论 MDRD改良方程法对CKD患者分期的准确率要优于肾动态显像法,其优越性主要体现在对肾衰竭期患者的分期中,而对其他各期的患者,两种方法的分期准确率差异则无统计学意义,然而,由于MDRD改良方程法更加简便、经济,临床实践中对CKD患者进行分期应首选MDRD改良方程法.

不同肾小球滤过率公式对接受经皮冠状动脉介入治疗急性心肌梗死患者全因死亡事件预测价值

目的探讨肾病饮食改良(MDRD)简化公式与慢性肾病流行病学合作研究(CKD-EPI)公式估算的肾小球滤过率(GFR)对接受经皮冠状动脉介入(PCI)治疗的急性心肌梗死(AMI)患者全因死亡事件的预测价值。方法选取北部战区总医院心血管内科自2016年3月至2019年3月收治的2488例接受PCI治疗的AMI患者为研究对象。所有患者分别采用MDRD简化公式与CKD-EPI公式估算GFR值。研究终点为12个月内的全因死亡事件。对所有患者进行电话或门诊随访,记录两种公式估算的GFR结果、患者冠状动脉造影病变基线特征、出院用药情况及临床结局。比较两种公式估算的各GFR分层全因死亡发生率。结果MDRD简化公式、CKD-EPI公式估算的GFR分别为(86.07±25.36)ml/(min·1.73 m^(2))、(84.78±23.60)ml/(min·1.73 m^(2))。出院后12个月,105例(4.22%)患者出现全因死亡,85例(3.42%)患者出现心源性死亡,26例(1.05%)患者出现心肌梗死,15例(0.60%)患者出现脑卒中。MDRD简化公式、CKD-EPI公式估算的GFR不同分层的全因死亡发生率比较,差异均有统计学意义(P<0.05)。CKD-EPI公式的统计量大于MDRD简化公式(9.3545比8.9565)。结论接受PCI治疗的AMI患者中,CKD-EPI公式与MDRD简化公式估算的GFR对出院后12个月全因死亡事件均有一定预测价值,CKD-EPI公式预测准确度优于MDRD简化公式。