三种CKD-EPI公式在女性慢性肾病人群中估算肾小球滤过率的比较

目的评价在我国女性慢性肾病(CKD)患者人群中3种CKD-EPI公式计算肾小球滤过率估算值(eGFR)的性能。方法将2010年1月至2015年1月在江苏省中医院肾内科住院的女性CKD患者75例纳入本研究,收集患者的一般资料、血清肌酐(Cr)水平、血清胱抑素C(CycC)水平和99 mTc-DTPA肾动态显像资料。以99 mTc-DTPA肾动态显像法所测肾小球滤过率(GFR)为金标准,用3种CKD-EPI公式(EPI_(Scr)、EPI_(CysC)和EPI_(Scr-CysC))估算eGFR,比较3种公式的偏倚、准确性和95%一致性范围。结果整体公式性能比较,偏倚方面三种公式绝对偏倚比较差异无统计学意义(P0.05);准确度方面:相对偏倚在±30%范围内百分率,CKD-EPICysC与CKD-EPI_(Scr)公式间比较差异有统计学意义(66.67%vs.56.00%,P0.05);一致性方面:BlandAltman散点图显示,CKD-EPI_(Scr-CysC)、CKD-EPI_(Scr)、CKD-EPI_(CysC)公式的95%一致性范围分别为(-33.0%,36.1%)、(-38.4%,35.7%)和(-33.7%,36.6%)。CKD早期,偏倚和准确度方面三个公式比较差异无统计学意义(P0.05),一致性方面:CKDEPI_(Scr-CysC)、CKD-EPI_(Scr)和CKD-EPI_(CysC)公式的95%一致性范围分别为(-33.5%,36.9%)、(-39.0%,36.4%)和(-34.3%,37.5%)。结论尽管CKD-EPI_(Scr-CysC)公式在评估中表现最为优秀,但三种CKD-EPI公式性能差异并不十分明显,在临床实际中仍需综合考虑。

Comparison among three kinds of CKD-EPI formula for estimating glomerular filtration rate in female patients with chronic kidney disease

Objective To evaluate the performance of the three kinds of chronic kidney disease epidemiology collaboration(CKD‐EPI) formula for estimating glomerular filtration rate(GFR) in Chinese female patients with chronic kidney disease(CKD) .Methods Seventy‐five female patients with CKD hospitalized in the nephrology department of Jiangsu Provincial Hospital of Traditional Chinese Medicine from January 2010 to January 2015 were included in this study .The general data ,serum creatinine(Cr) and CysC levels and 99 mTc‐DTPA renal dynamic imaging were collected with GFR detected by using the 99 mTc‐DTPA renal dynamic imaging as the GFR gold standard .GFR was respectively as EPIScr ,EPICysC and EPIScr‐CysC by the three kinds of CKD‐EPI formula .The bias , accuracy and 95% consistency range were compared among the three kinds of formula .Results In the comparison of the total for‐mula performance ,the absolute bias had no statistical difference among them ( P > 0 .05) .However in the percentage within the range of ± 30% ,the difference in acicuracy between the formula CKD‐EPICysC and CKD‐EPIScr had statistical significance(66 .67%vs .56% ,P< 0 .05) .In the aspect of consistency ,the Bland‐Altmanthe scatter diagram showed that the 95% consistency ranges of formula CKD‐EPIScr‐CysC ,CKD‐EPIScr and CKD‐EPICysC were ( - 33 .0% ,36 .1% ) ,( - 38 .4% ,35 .7% ) and ( - 33 .7% ,36 .6% ) re‐spectively .In the early stage of CKD ,the bias and accuracy had no statistical difference among the three formulas(P > 0 .05) .In the aspect of consistency ,the Bland‐Altman scatter diagram calculation showed that the consistency range of formula CKD‐EPIScr‐CysC was smaller than that of formula CKD‐EPIScr and CKD‐EPICysC ,which were ( - 33 .5% ,36 .9% ) ,( - 39 .0% ,36 .4% ) and ( - 34 .3% ,37 .5% )respectively .Conclusion Although the formula CKD‐EPIScr‐CysC equation shows most excellent in evaluation ,but the differences among the three formulas are not obvious .So it is still necessary to do comprehensive consideration in clinical prac‐tice .