6种基于血肌酐的肾小球滤过率估算公式在健康人群中的应用评估

目的评价基于酶法和苦味酸速率法的血清肌酐的6种估算的肾小球滤过率（eGFR）公式在表观健康人群中的适用性。方法从健康体检人群中筛选出694名表观健康人，分别用酶学方法和碱性苦味酸速率法检测血清肌酐，通过6种eGFR公式Cockcroft—Gault（C—G）公式、简化肾脏病膳食改善（MDRD）公式、MDRD-中国人公式、同位素稀释质谱法（IDMS）-MDRD公式、慢性肾脏病流行病合作组（CKD-EPI）公式和EPI-亚洲人（EPI-Asian）公式]分别计算其eGFR并进行比较。结果694名表观健康人群的血肌酐检测结果分别为酶法（65．8±13．3）μmolfL（范围为36～117μmol／L），苦味酸速率法（83．0±12．7）μmol／L（范围为57～131μmol／L）。以eGFR值男性85—125mL／min、女性75—115mL／min作为参考区间，基于酶法检测肌酐的eGFR值在表观健康人群中的适用性依次为CKD—EPI公式（72．3％）〉IDMS—MDRD公式（69．9％）〉简化MDRD公式（61．3％）〉EPI—Asian公式（60．7％）〉C—G公式（54．8％）〉MDRD一中国人公式（27．3％）（P〈0．05），IDMS—MDRD公式在男、女性之间的适用性差异最小（仅相差1．6％）；基于苦味酸速率法检测肌酐的eGFR值在表观健康人群中的适用性依次为MDRD一中国人公式（80．0％）〉EPI—Asian公式（70．1％）〉CKD—EPI公式（63．8％％）〉简化MDRD公式（59．1％）〉C—G公式（52．4％）〉IDMS—MDRD公式（40．7％）（P〈0．05），MDRD-中国人公式在男、女性之间的适用性差异最小（仅相差1％）。结论以上6种eGFR公式计算结果有明显差异。如果用溯源至IDMS的酶法检测血清肌酐，可选用CKD—EPI公式、IDMS—MDRD公式来评价中国北方健康人群的eGFR；如果用苦味酸速率法检测血清肌酐，可选用MDRD-中国人公式来评价中国北方健康人群的eGFR。

Evaluation on the application of 6 creatinine-based equations of estimated glomerular filtration rate in healthy population

Objective To evaluate the application of 6 creatinine-based equations of estimated glomerular filtration rate （eGFR） by enzymatic method and kinetic alkaline picric acid rate method in healthy population. Methods Serum creatinine was measured by enzymatic method and kinetic alkaline picric acid rate method in 694 healthy subjects. The eGFR values were calculated and compared by 6 equations Cockcroft-Ganh （C-G） equation, simplified modification of diet in renal disease （MDRD） equation, MDRD-Chinese equation, isotopic dilution mass spectrometry （IDMS）-MDRD equation, chronic kidney disease epidemiology collaboration （CKD-EPI） equation and CKD-EPI for Asian （EPI-Asian） equation]. Results Serum creatinine results were（65.8 ＋ 13.3） ~mol/L （36-117） ~mol/L） for enzymatic method, （83.0 ＋ 12.7） ~mol/L （57-131）~mol/L~ for kinetic alkaline picric acid rate method. According to eGFR reference intervals： 85-125mL/min for males and 75-115mL/min for females, if using enzymatic method to detect creatinine, the applicability in healthy subjects of 6 equations were CKD-EPI equation （72.3%） 〉 IDMS-MDRD equation（69.9% ） 〉 simplified MDRD equation（61.3% ） 〉 EPI-Asian equation （60.7%） 〉 C-G equation（54.8% ） 〉 MDRD-Chinese people equation （27.3%）（P 〈 0. 05）,and IDMS-MDRD equation showed the smallest difference between males and females （only 1.6% ）. If using kinetic alkaline picric acid rate method,the applicabilities in healthy subjects of 4 equations were MDRD-Chinese people equation（80. 0% ） 〉 EPI-Asian equation （70. 1% ） 〉 CKD-EPI equation （63.8%） 〉 simplified MDRD equation（59.1% ） 〉 C-G equation（52.4% ） 〉 IDMS-MDRD equation（d0.7% ） （P 〈0.05） ,and MDRD-Chinese people equation showed the smallest difference between males and females （only 1% ）. Conclusions There are significant differences among 6 equations. To evaluate eGFR in healthy subjects in North China, CKD-EPI equation and IDMS-MDRD equation are more applicable if using enzymatic mehod traced to IDMS to detect serum creatnine ,while MDRD-Chinese people equation is more applicable if using kinetic alkaline picric acid rate method to detect serum creatnine.