目的：评估不同肾小球滤过率( GFR)估算公式在我国糖尿病患者中的临床应用价值。方法选取2014年2—10月蚌埠医学院第一附属医院内分泌科入院的225例糖尿病患者,记录其性别、年龄、病程等资料,检测血清胱抑素C ( Cys-C)、血肌酐( SCr),使用GFR估算公式MDRD、 rMDRD、 CKD-EPI、瑞金方程、 Macisaac计算GFR估计值( eGFR),同时行同位素99m Tc-DTPA肾动态显像法得出GFR参考值( ECT-GFR)。结果 MDRD-eGFR、rMDRD-eGFR、 SQRT CKD-EPI-eGFR、瑞金方程-eGFR、 SQRT Macisaac-eGFR均高于ECT-GFR,差异有统计学意义(t=18．149、17．964、11．952、12．766、6．404, P<0．05)。不同GFR分期、性别、年龄、病程的患者各估算公式eGFR与ECT-GFR均呈直线正相关(P<0．01)。利用Bland-Altman作图法评价各eGFR与GFR之间的一致程度,结果显示使用Macisaac公式Cys-C计算的eGFR与GFR的偏差值均数最小,表明二者相符程度较好。结论采用各公式估算GFR时,以Macisaac公式评价GFR适用性相对较好,5种GFR评估公式在我国糖尿病人群中的临床应用均有一定局限性,有待进一步改进。%Objective To investigate the application value of different estimation formulas for calculating glomerular filtration rate ( GFR) in Chinese patients with diabetes. Methods We enrolled 225 patients with diabetes who were admitted into the Department of Endocrinology of the First Affiliated Hospital of Bengbu Medical College from February to October 2014. Gender, age and disease course were recorded; Cys -C and SCr were detected; eGFR was calculated using MDRD, rMDRD, CKD-EPI, M-MDRD-GFR and Macisaac, and the reference value of GFR was worked out by 99m Tc-DTPA renal dynamic imaging. Results MDRD -eGFR, rMDRD -eGFR, SQRT CKD -EPI -eGFR, M -MDRD -GFR -eGFR and SQRT Macisaac-eGFR were higher than ECT -GFR (t =18. 149, 17. 964, 11. 952, 12. 766, 6. 404; P <0. 05). eGFR values worked out by different formulas and of patients with different GFR staging, gender, age and disease course had positive linear correlation with ECT-GFR (P<0. 01). The evaluation of the consistent degree between eGFR and GFR by using Bland-Altman plot showed that Macisaac formula used for Cys-C had the smallest mean deviation, which indicates that the two had better consistent degree. Conclusion Macisaac formula has better applicability in evaluating GFR. The five estimation formulas have limitations in clinical application among diabetic population, further improvement needs to be made.
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