不同肾小球滤过率方程在中国糖尿病患者的临床应用及评价

A Comparison of Different Estimation Equations for Glomerular Filtration Rate in Chinese Diabetic Patients

中文关键词:  糖尿病肾脏疾病 肾小球率过滤 评估方程

英文关键词:Diabetic kidney disease Glomerular filtration rate (GFR) Evaluation equation

中文摘要:

      目的 评价C-G方程、简化MDRD方程、中国方程、瑞金方程、CKD-EPI方程所估算的肾小球滤过率（GFR）值在中国糖尿病患者临床应用中的准确性、精确性以及相关性，筛选出适合我国糖尿病患者的eGFR预测公式。 方法 纳入年龄≥18岁的门诊及住院糖尿病患者，记录患者临床资料。采用^99mTc-DTPA测定肾小球滤过率作为GFR的参考值（rGFR），分别采用以上5个方程估算GFR（eGFR）并与rGFR进行比较。并根据rGFR、受试者血清肌酐和空腹血糖水平，进一步将受试者分成不同组别，比较不同rGFR、不同血清肌酐水平以及不同的血糖水平是否会影响上述各方程所估算的GFR值准确性、精确性和相关性。 结果 本研究共纳入217例糖尿病患者，其中男性139例，女性78例。与rGFR比较，C-G方程略低估了GFR，而简化MDRD方程、中国方程、瑞金方程和CKD-EPI方程均略高估了GFR，采用瑞金方程估算的eGFR值准确性和精确性最高，其次为CKD-EPI方程。当患者血清肌酐水平正常（≤133 μmol/L）时，采用瑞金方程计算 eGFR值准确性和精确性最高；当血清肌酐水平在133~177 μmol/L时，用CKD-EPI方程计算的eGFR值准确性和精确性最高；当血清肌酐水平大于177 μmol/L时，采用各公式计算的eGFR值准确性和精确性之间无明显差异。无论空腹血糖水平在何范围，均以瑞金方程所得eGFR值准确性和精确性最高。 结论 采用各方程估算中国糖尿病人群的GFR时，以瑞金方程评价GFR适用性最好，其次为CKD-EPI方程。糖尿病患者血糖水平对各方程式估算GFR值准确性和精确性的影响不大。

英文摘要:

      Objective To compare the accuracy and precision of C-G equation, simplified MDRD equation, the Chinese equation, Ruijin equation, and CKD-EPI equation for estimating glomerular filtration rate (GFR) in Chinese diabetic patients.Methods Diabetic patients visiting the West China Hospital (both outpatient and inpatient departments) of Sichuan University who were older than 18 years old were enrolled in this study. Their general health and clinical characteristics were recorded. The GFR of those patients were evaluated by ^99mTc-DTPA dynamic renal imaging (rGFR). We compared the accuracy and precision of C-G equation, simplified MDRD equation, the Chinese equation, Ruijin equation and CKD-EPI equation for estimating GFR (eGFR). We also tested whether levels of GFR, plasma creatinine (Scr) and fasting plasma glucose (FPG) influenced the accuracy and precision of the equations. Results 217 diabetic patients (139 males and 78 females) were enrolled in this study. Compared with rGFR, C-G equation underestimated GFR slightly; whereas simplified MDRD equation, the Chinese equation, Ruijin equation and CKD-EPI equation overestimated GFR. Ruijin equation had the best accuracy and precision in all the equations, followed by CKD-EPI equation. When patients had lower than 133 μml/L Scr, Ruijin equation had the best accuracy and precision. When patients had 133-177 μmol/L Scr, CKD-EPI equation had the best accuracy and precision. When patients had higher than 177 μmol/L Scr, there was no obvious difference in accuracy and precision among the equations. Regardless of the level of FPG, Ruijin equation had the best accuracy and precision in all the equations.Conclusion Ruijin equation is the best equation for estimating GFR, followed by CKD-EPI equation.