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首页> 中文期刊> 《南方医科大学学报》 >8种eGFR估算方程评价心血管病患者肾小球滤过率的诊断价值比较

8种eGFR估算方程评价心血管病患者肾小球滤过率的诊断价值比较

         
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Objective To assess the diagnostic value of 8 equations using different variables for determining the estimated glomerular filtration rate (eGFR) in patients with cardiovascular diseases. Methods GFR was estimated in 208 patients with cardiovascular diseases by Tc-DTPA dynamic renal imaging, and the eGFR was derived from 8 equations using different variables. Results In patients with chronic kidney disease (CKD) stages 1-3, the eGFR calculated suing serum creatinine (SCr)-based equation was better correlated to GFR estimated by ""Tc-DTPA renal imaging than that derived from cystatin C (Cys C)-based equations, whereas in patients with CKD stages 4 and 5, the estimates by the latter equation showed a better correlation to GFR. Compared with Tc-DTPA renal imaging, MDRD-based equation and simple MDRD equation resulted in a higher eGFR in patients with CKD stages 4 and 5, the Rule equation had a lower eGFR in CKD stages 1 and 2, the Macisaac equation yielded a higher eGFR in CKD stages 2-5, and the Tan equation showed a higher eGFR in CKD stages 2 and 3. In patients with mild renal dysfunction, the Scr-based equation had a higher AUCROC than Cys C-based equation, which was reversed in patients with severe renal dysfunction; the AUCROC of the two equations were comparable in patients with moderate renal dysfunction. Compared with Tc-DTPA renal imaging, the modified MDRD equation and Arnal-Dade equation showed no significant difference in the eGFR in patients with CKD stages 1-5. Conclusion Modified MDRD equation (or simple MDRD equation) and Arnal-Dade equation are superior to other calculation methods for estimating the GFR in Chinese patients with cardiovascular disease.%目的 比较8种估算的肾小球滤过率(eGFR)估算方程评价心血管病患者GFR的诊断价值.方法 选择以99mTc-DTPA肾动态显像法进行GFR检测的208例患者,测量血浆Cr、Cys-C并使用各种eGFR估算方程计算出相应eGFR.结果 (1)在慢性肾脏病(CKD)1～3期.Scr-eGFR估算方程与同位素GFR的相关性明显高于Cys-eGFR估算方程,在CKD4、5期,Cys-eGFR估算方程与GFR相关性略高于Scr-eGFR估算方程.(2)MDRD、简化MDRD会高估CKD4、5期患者GFR,Rule方程在CKD1、2期患者出现低估.Macisaac方程在CKD2～5期均高估GFR,Tan方程则在CKD2、3期出现高估.(3)轻度肾衰竭患者Scr-eGFR估算方程的ROC曲线下面积(AUCROC)高于Cys-eGFR估算方程,中度肾衰竭患者Scr-eGFR估算方程的AUCROC与Cys-eGFR估算方程并无明显差异,而重度肾衰竭患者Cys-eGFR估算方程的AUCROC高于Scr-eGFR估算方程.(4)与99mTc-DTPA肾动态显像法测定的GFR参考值相比较,各CKD分期均无明显差异的eGFR评估方程有:基于Scr的改良MDRD方程和基于Cys-C的Arnal-Dade方程.结论 改良MDRD方程(或简化MDRD方程)和Amal-Dade方程更适于国内心血管病患者eGFR的评估.

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