| 李飞,邓庆梅,黄山,张罡,张敬苗.肾小球滤过率评估方程在糖尿病患者中的应用[J].中国医学影像技术,2017,33(8):1246~1251 |
| 肾小球滤过率评估方程在糖尿病患者中的应用 |
| Application of estimation equations for glomerular filtration rate intype 2 diabetes mellitus |
| 投稿时间：2016-12-25 修订日期：2017-02-23 |
| DOI：10.13929/j.1003-3289.201703111 |
| 中文关键词: 糖尿病,2型 肾小球滤过率 肾小球滤过率评估方程 |
| 英文关键词:Diabetes mellitus,type 2 Glomerular filtration rate Estimated glomerular filtration rate equations |
| 基金项目: |
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| 中文摘要: |
| 目的 评估美国慢性肾脏病流行病学协作组（CKD-EPI）系列方程及修正方程预测糖尿病患者肾小球滤过率（GFR）的效能，包括CKD-EPI肌酐（Scr）方程（CKD-EPIscr）、CKD-EPI半胱氨酸蛋白酶抑制剂C（SCysC）方程（CKD-EPIscysc）、CKD-EPI Scr和SCysC混合方程（CKD-EPIScr-SCysC）、亚洲CKD-EPI方程（CKD-EPI亚洲）、中国糖尿病CKD-EPI方程（CKD-EPI糖尿病）及改良肾脏病膳食改良实验（MDRD）、Cockcroft-Gault（CG）方程、简化MDRD方程。方法 采用碱性苦味酸法测定血清Scr，胶乳增强免疫透射比浊法测定血清ScysC，99mTc-DTPA肾动态显像法测定GFR，并经体表面积标准化后获得rGFR。分析Scr、ScysC、各方程计算获得GFR（eGFR）与rGFR的相关性，并比较各方程的30%符合率、各方程eGFR与rGFR的偏差和偏离程度及一致性。以rGFR<60 ml/（min·1.73 m2）为诊断肾功能不全的标准，采用ROC曲线分析各公式eGFR诊断肾功能不全的效能。结果 Scr、Scys与rGFR呈负相关（P均<0.001）；各方程CKD-EPIScr、CKD-EPIScysC、CKD-EPIScr-SCysC、CKD-EPI亚洲、CKD-EPI糖尿病、改良MDRD、CG、简化MDRD测量的eGFR与rGFR均呈正相关（P均<0.001）。CKD-EPI糖尿病、简化MDRD测量的eGFR与rGFR30%符合率较高；CKD-EPIScr、CKD-EPI亚洲、CKD-EPI糖尿病、改良MDRD测得的eGFR与rGFR差异无统计学意义（P均>0.05）；CKD-EPI糖尿病测量的eGFR与rGFR一致性最好，其余所有公式一致性均超过预定的界限。ROC曲线示CKD-EPI糖尿病测量的eGFR曲线下面积最大、Youden指数最高。结论 8种公式预测的eGFR均存在不同程度偏差，中国2型糖尿病方程CKD-EPI准确率和一致性最佳。 |
| 英文摘要: |
| Objective To investigate the application value of chronic kidney disease epidemiology collaboration (CKD-EPI) equations and amendatory equations for calculating glomerular filtration rate (GFR) in Chinese patients with diabetes,including CKD-EPI serum creatinine (Scr) equation (CKD-EPIscr),CKD-EPI serum cystatin C (ScysC) equation (CKD-EPIscysc),combination of CKD-EPIscr and CKD-EPIScr-SCysC(CKD-EPIScr-SCysC),Asian modified CKD-EPI equation (CKD-EPIAsian),Chinese diabetes CKD-EPI equation (CKD-EPIDiabetes),refitted modification of diet in renal disease (MDRD) equation (rMDRD),Cockcroft-Gault equation (CG) and Simplified MDRD equation.Methods Serum creatinine (Scr) was detected using basic picric acid method,serum cystatin C (CysC) was measured by Latex enhanced turbidimetric,and the reference value of GFR was worked out by 99Tcm-DTPA renal dynamic imaging and standardization of body surface area.Relation of Scr,Scysc,GFR measured by every equations and rGFR were analyzed.The accuracy of 30% of each equation,the consistency and deviation of the evaluation of renal function by each equation were compared.The diagnostic efficacy in GFR<60 ml/(min · 1.73 m2) was compared using the receiver operating characteristic (ROC) curve.Results The rGFR had negative correlation with Scr、ScysC (both P<0.001).The rGFR had positive correlation with GFR measured by CKD-EPIScr,CKD-EPIScysC,CKD-EPIScr-SCysC,CKD-EPIAsian,CKD-EPIDiabetes,rMDRD,CG and Simplified MDRD (all P<0.001).The coincidence rate between 30% of rGFR and GFR measured by CKD-EPIDiabetes and simplified MDRD were higher.There was no significant difference of rGFR and GFR measured by CKD-EPIScr,CKD-EPIScysC,CKD-EPIScr-SCysC,CKD-EPIAsian,CKD-EPIDiabetes,rMDRD,CG and Simplified MDRD.GFR measured by CKD-EPIDiabetes has the best consistent degree with rGFR.ROC curve showed that the area under curve of GFR measured by CKD-EPIDiabetes was largest and the Youden index was the highest.Conclusion There are different degrees of deviation in eGFR predicted by the eight kinds of equations.The accuracy and consistency of CKD-EPIDiabetes in Chinese 2-type diabetes is the best. |
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