三种肾小球滤过率预测公式在肾脏肿瘤患者肾功能评估中的应用

目的:评价肾小球滤过率(GFR)预测公式在肾肿瘤患者肾功能评估中的应用价值。方法:选取2010年9月~2013年6月收治的肾肿瘤患者73例,以99mTc-DTPA肾动态显像法测得的rGFR为金标准,计算慢性肾脏病流行病学合作研究(CKD-EPI)公式、简化MDRD公式及中国改良简化MDRD公式的预测eGFR与其相关性,及不同分割点时各公式诊断的敏感性。结果:三个公式的eGFR值与rGFR值有很好的相关性(相关系数分别为r=0.658,P=0.001;r=0.806,P=0.000;r=0.795,P=0.000)。当分别以90或60ml·min-1·1.73 m-2为诊断分割点时,受试者工作特征曲线(ROC)曲线下面积比较差异无统计学意义。结论:3种公式均具有较好的预测肾脏肿瘤患者GFR的能力,可作为有效的肾功能评价的指标。     

多种肾小球滤过率的估算方程在活体供肾者肾功能评估中的适用性研究

目的 比较多种肾小球滤过率(GFR)估算方程在亲属活体供肾功能评估中的准确性,找出适合我国人群的GFR估算方程.方法 以44名亲属活体供肾者为对象,以99mTc-二乙三胺五乙酸(DTPA)肾动态显像测定的GFR为参考标准,并以体表面积(BSA)将其标准化(sGFR).将以Cockcroft-GauIt(C-G)方程估算的肌酐清除率(Ccr),C-G方程、改良C-G方程、肾脏疾病饮食调整研究组(MDRD)方程和改良MDRD方程估算的GFR(eGFR),分别与sGFR进行比较,分析其偏差、相关性、准确性和精确性.结果 sGFR为(123±24)ml/min,C-G方程估算的Ccr,以及C-G方程、改良C-G方程、MDRD方程和改良MDRD方程估算的GFR分别为(123±27)ml/min、(104±22)ml/min、(156±28)ml/min、(122±19)ml/min和(138±25)ml/min,其偏差值,MDRD方程最小,两种改良方程的偏差较大;配对t检验及相关性分析,C-G方程的Ccr估算值、MDRD方程的估算值与sGFR的差异无统计学意义,改良C-G方程和改良MDRD方程的GFR估算值与sGFR之间的相关性较好;MDRD方程的准确性最高,两种改良方程的准确性较差;改良MDRD方程、改良C-G方程的精确性稍高.结论 5个估算方程估算的GFR均有不用程度的误差,相对来说MDRD方程的偏差较小,准确性较高,相关性和精确性尚可,但若应用于临床,有必要对其进行适当修正.     

碘海醇血浆清除率测定肾小球滤过率与临床常用的估算肾小球滤过率方法的比较

目的采用碘海醇血浆清除率测定肾小球滤过率(mGFR)与临床常用方法评估估算肾小球滤过率(eGFR)的准确性比较。方法选取2019年6月至2020年6月在本院自愿参加测试的145例研究对象, 根据eGFR值进行分组:1期[eGFR≥90 mL·(min·1.73 m2)-1, 37例]、2期[eGFR 60～90 mL·(min·1.73 m2)-1, 39例]、3期[eGFR 30～60 mL·(min·1.73 m2)-1, 47例]、4期[eGFR 15～30 mL·(min·1.73 m2)-1, 17例]、5期[eGFR <15 mL·(min·1.73 m2)-1, 5例], 所有研究对象通过静脉注射碘海醇5 mL后, 在注射后0、2 h和4～6 h间取血浆样本3次, 测量血浆清除率, 进行肾功能评估, 并与常用的肾功能评估公式[MDRD、内生肌酐清除率(Ccr)、CKD-EPI、Cockcroft-Gault]进行比较。结果 Ccr、MDRD公式计算eGFR值高于采用碘海醇血浆清除率计算的mGFR值(均P<0.05), 而Cockcroft-Gault、CKD-...     

不同方法对肾功能评估的价值

目的探讨临床上常用的几种肾功能评估方法的相对准确性,寻求更为简便、快捷的肾功能评估方法。方法选择慢性肾脏病（CKD）患者80例,分别用^99mTc-DTPA肾动态显像法测定肾小球滤过率（GFR）,同时检测患者血肌酐（SCr）、血清胱抑素C（CysC）浓度,根据SCr分别用Cock-croft-Gault（C-G）方程和简化MDRD方程估算肾小球滤过率（分别为eGFR1、eGFR2）。按GFR值将患者分为4组,即A组：CKD1期;B组：CKD2期;C组：CKD3期;D组：CKD4期;排除CKD5期的患者。观察所有和各组患者eGFR1、eGFR2、SCr、CysC与GFR的相关性。结果总样本中,eGFR1、eGFR2与GFR呈正相关,SCr、CysC与GFR呈负相关（P〈0．01）。在各组中,A组：eGFR1、eGFR2、SCr与GFR之间均无明显相关性（P〉0．05）;而B、C、D组中eGFR1、eGFR2与GFR呈正相关（P〈0．01）,SCr与GFR呈负相关（P〈0．05）;CysC在A、B、C、D各组中均与GFR呈负相关（P〈0．01）。结论CKD2、3、4期患者eGFR1、eGFR2、SCr与GFR均有一定的相关性,但不论何期CKD患者,CysC均能准确反映其肾功能状况,且更加简便、快捷。     

老年患者炎症因子水平与肾性贫血的相关分析

目的 探讨老年患者贫血的发生与炎症因子水平及。肾功能的相关性。方法 选择老年患者（年龄≥60岁）200例为研究对象,另设30例健康体检者为正常对照组。根据血红蛋白水平将200例老年患者分为贫血组和非贫血组;根据估算肾小球滤过率（eGFR）又分为A组[eGFR〉50ml·min^-1·（1．73m^2）^-1]、B组[eGFR30～50ml min^-1·（1．73m^2）^-1和C组[eGFR〈30mlmin^-1·（1．73m^2）^-1],测定血清超敏C反应蛋白（hs-CRP）、白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）水平。结果随着肾功能水平减退,贫血患病率逐渐增高,血清hs-CRP、IL-6、TNF-α水平亦逐渐增高,但仅hs-CRP组间有显著差异（P〈0．05）;血清hs-CRP、IL-6、TNF-α与血红蛋白均呈负相关（r=-0．271、-0．148、-0．155,P〈0．05）;hs-CRP、TNF-α与eGFR亦呈负相关（r=-0．140、-0．142,P〈0．05）,IL-6与eGFR无相关性。结论老年人肾功能减退时的高贫血患病率与炎症因子参与的致病机制有关;hs-CRP在评价。肾功能减退者的机体炎症状态时优于TNF-α和IL-6。     

不同公式估算慢性肾脏病患者肾小球滤过率的结果评价

目的探讨不同估算公式估算慢性肾脏病（CKD）患者肾小球滤过率（GFR）在肾功能评价中的价值。方法选择CKD患者239例,所有患者同步检测99锝-二乙烯三胺五乙酸（^99mTc-DTPA）、GFR、血肌酐（SCr）等。将^99mTc-DTPA测定的GFR作为参照,并用肾脏病膳食改良试验（MDRD）公式、Cockcroft-Gault公式、简化MDRD公式及慢性肾脏病流行病合作研究（cKD-EPI）公式计算估测GFR,比较不同CKD分期中各估算公式估算的GFR的准确性。结果各估算公式估算的GFR值均高于^99mTc-DTPA,MDRD公式偏离程度最大;各估算公式估算的GFR值与^99mTc-DTPA检查的GFR结果有相关性,CKD-EPI公式相关性最高。结论CKD-EPI公式估算肾功能更接近^99mTc-DTPA的结果,但仍需进一步校正。     

不同肾功能评估公式在PAP酶法肌酐检测时临床适用性比较

目的：探讨不同肾小球滤过率（GFR）计算公式在肾功能评估中的差异。方法：以99mTc-DTPA肾动态显像法检测的GFR（rGFR）为参照值,对263例符合CKD入选标准的患者采用PAP酶法检测Scr,并对CG公式、MDRD公式、简化MDRD公式和中国人改良MDRD公式（C-MDRD）进行偏离度、精确度和准确性比较。结果：rGFR与CG、MDRD、简化MDRD和C-MDRD估测的eGFR均呈显著相关,r分别是0.821、0.870、0.856、0.856（均P〈0.001）。4种公式的偏离度分别是1221.04、2172.12、2518.45和7295.78,绝对偏差的中位数分别是：14.57、12.48、14.44和25.55;C-MDRD公式与其他3种公式有统计学差异（P〈0.001）,30%准确性分别是60.5%、61.2%、56.3%和38.8%。结论：本组患者行CG、MDRD、简化MDRD和C-MDRD公式估测的eGFR与rGFR相关性好;在PAP酶法测定肌酐条件下,综合偏离度、精确度和准确性分析,MDRD公式临床适用性最佳,而C-MDRD公式最差。     

胱抑素C及CGFR评价慢性肾脏病肾功能的临床意义

目的：本文测定各期慢性肾脏病（CKD）患者的胱抑素C与血清肌酐（Scr）,分析二者异常表达率,并探讨依据CysC计算的CGFR与MDRD公式计算的eGFR的相关性,寻找方便、灵敏、准确评价肾功能的指标。方法：将172例CKD患者依据MDRD公式计算的eGFR进行分期（美国NKF-K/DOQI指南）,分别测定各期患者的Scr、血清尿素氮（BUN）、血清白蛋白（Alb）、胱抑素C（Cys C）,计算CGFR,分析CysC与Scr的异常表达率及CGFR与eGFR的相关性。结果：CKDⅠ期组患者Cys C和Scr诊断肾功能异常的敏感性分别为21.88%和0%,CKDⅡ期组分别为65%和15%,CKDⅢ期组分别为86.84%和97.37%,Ⅳ期与Ⅴ期组患者血清Cys C异常表达率与Scr相同,均达到100%。在各期CKD中,CGFR与eGFR均具有显著相关性（P〈0.01）。结论：CKD各期患者CGFR和eGFR密切相关,CGFR评估肾小球滤过率与MDRD计算评估的结果相符,CGFR与eGFR在判断肾功能方面具有一致性。而在CKDⅠ、Ⅱ、Ⅲ期患者血清Cys C异常表达率高于Scr,提示在肾功能损害早中期血清Cys C比Scr更敏感。Cys C及CGFR是评价肾功能的方便、灵敏、可靠的指标。     

肾性贫血的治疗进展

肾性贫血是慢性肾脏病（CKD）患者常见并发症之一,贫血程度与肾功能损害程度呈平行关系。PAERI研究结果显示,估计肾小球滤过率（eGFR）小于60ml·min-1（1．73m2）-1时,超过40％患者合并贫血,CKD5期患者此比例近80%。上海中山医院的小样本研究显示,     

不同肌酐测定方法对MDRD方程在IgA肾病患者中适用性的评价

目的：探讨不同的肌酐测定方法对适用不同MDRD公式估算肾小球滤过率（GFR）的影响。方法：回顾性分析1987年以来的IgA肾病患者数据库资料,获得完整数据2204例。根据肌酐测定方法的不同,分为A、B两组,A组采用比色法测定血肌酐,B组采用酶法测定血肌酐,分别采用简化MDRD公式和2005年IDMS-肌酐重新表述的MDRD公式计算GFR。采用Bland-Altman分析两者之间的偏差,并进一步探讨偏差和肌酐值之间的相关性。结果：在A组,与简化的MDRD公式相比,将比色法测定肌酐带入2005年MDRD公式所得GFR存在低估,平均差异-5．1ml·min^-1．73m^-2（95％CI～9．9-- -0.3）;在B组,与2005年MDRD公式相比,将酶法测定结果带入简化MDRD公式后造成对GFR的高估,平均相差5．1ml·min^-1·1．73m^-2（95％CI01～10．6）。相关分析和趋势检验显示随着肌酐的增加偏差减小。结论：不同肌酐测定方法适用不同的MDRD公式将出现偏差,在临床工作中需要根据肌酐测定方法选择不同的MDRD公式。     

Impact of different methods of estimating renal function on determining eligibility for cisplatin (CDDP)-based chemotherapy in patients with invasive urothelial carcinoma

Assessment of renal function is important to determine the appropriate dose for cisplatin (CDDP)-based chemotherapy. Many previous CDDP-based chemotherapy trials for bladder cancer have required a creatinine-clearance (Ccr) ≧60 ml/min for entry. However, there is little evidence on renal function assessed by estimated glomerular filtration rate (eGFR) using the 4-variable Modification of Diet in Renal Disease Study Equation (MDRD), which has recently been introduced, to determine the eligibility for CDDP-based chemotherapy. To evaluate the proportion of patients with invasive urothelial carcinoma(UC) who would be ineligible ("unfit") to receive CDDP-based chemotherapy based on eGFR criteria (eGFR ＜60 ml/min/1.73 m2), and to determine the side effects of chemotherapy in these "unfit" patients, we conducted a retrospective clinical study. Our study population consisted of 61 consecutive patients who underwent 100% dose CDDP-based chemotherapy for invasive UC with 24 h-Ccr≧50 ml/min between June 2001 and July 2009. We assessed renal function using 3 equations (eGFR, Ccr according to Cockcroft-Gault formula (C-G Ccr), and Ccr examined by 24-hour urine collection (24 h-Ccr)) as well. Mean values of eGFR, C-G Ccr, and 24 h-Ccr were 58.6, 68.9, and 82.8 ml/min, respectively (P＜ 0.001). In total, 29/61(48%) patients were ineligible ("unfit") to receive chemotherapy based on eGFR criteria. However, there was no difference in the frequency of side effects between eGFR ≧60 ml/min/ 1.73 m2 and eGFR ＜60 ml/min/1.73 m2 groups. Our observations suggest that 24 h-Ccr≧50 ml/min would be a reasonable cutoff for CDDP-based chemotherapy even when eGFR ＜60 ml/min/1.73 m2.     

氯沙坦和阿魏酸哌嗪对老年高血压病患者肾脏保护作用

目的观察氯沙坦和阿魏酸哌嗪对老年高血压病患者肾脏保护作用。方法选择原发性高血压合并估算肾小球滤过率（eGFR）降低的老年患者107例,eGFR15～89ml·min^-1·（1．73m^2）^-1,以苯磺酸左旋氨氯地平片为基础降压药,随机分为氯沙坦组（A组）、阿魏酸哌嗪组（B组）和氯沙坦联合阿魏酸哌嗪组（C组）,观察时间为12个月。比较各组治疗前和治疗后第6、12个月及同一时间点各组间血肌酐（SCr）、内生肌酐清除率（Ccr）、eGFR和肾动脉阻力指数（RI）的差异。结果3组各级肾动脉RI均显著降低。A组SCr显著升高（P〈0．05）,Ccr和eGFR显著降低（P〈0．01和P〈0．05）;B组SCr呈降低趋势,Cer和eGFR有升高趋势;C组各指标无明显变化。结论氯沙坦和阿魏酸哌嗪均有肾脏保护作用;氯沙坦联合阿魏酸哌嗪可减缓Cer和eGFR下降速度,早期降低肾动脉RI,延缓肾损害发展进程。     

慢性肾脏病患者血清胎球蛋白A水平的测定和意义

目的：测定慢性肾脏病（CKD）患者血清中胎球蛋白A（FA）的水平,探讨FA在CKD患者中的表达,为CKD患者早期血管钙化的临床干预提供思路.方法：实验组：选择2013年1月～2013年12月在定西市人民医院肾内科治疗的CKD未透析患者90例,肾小球滤过率（glomeruarfiltrationrate,GFR）计算参照MDRD公式并依据CKD分期,将90例患者分为3个组,A组：eGFR≥60ml·min-1· 1.73 m-2（CKD1、2期）、B组：eGFR 30～59 ml·min-1· 1.73 m-2（CKD3期）、C组：eGFR≤29 ml·min-1·1.73 m-2（CKD4、5期）.对照组：同期在定西市人民医院体检中心选取30例年龄、性别相匹配的健康体检者.两组均抽取空腹静脉血,用ELISA法测定血清FA水平;同时测定血清白蛋白（Alb）,血清钙（Ca）,血清磷（P）,血iPTH等.采用SPSS 17.0统计软件对得出的数据进行处理.结果：（1）实验组与对照组比较：B组与对照组比较,FA水平低于对照组（P＜0.05）;C组与对照组比较,FA水平低于对照组（P＜0.05）,血磷水平高于对照组（P＜0.05）;（2）实验组组间进行比较：A组与B组：B组FA水平低于A组（P＜0.05）;C组与B组：C组FA水平低于B组（P＜0.05）.C组血磷水平高于B组（P＜0.05）;实验A组与实验C组：实验C组FA水平低于实验A组（P＜0.05）.实验C组血磷水平高于实验A组（P＜0.05）;（3）相关性分析结果显示,血清胎球蛋白A与血磷、钙磷乘积负相关（P＜0.05）.与白蛋白水平正相关（P＜0.05）.结论：（1）随着肾功能的下降,FA水平也下降,eGFR 30～59 ml/min（CKD3期）时,FA水平下降明显.（2）在CKD患者中,FA水平与血白蛋白成正相关,与血磷、钙磷乘积成负相关.     

Validation of cystatin C-based equations for evaluation of residual renal function among patients undergoing continuous ambulatory peritoneal dialysis

Objective To validate cystatin (Cys C)-based equations for evaluation of residual renal function （RRF） in patients on continuous ambulatory peritoneal dialysis (CAPD). Methods Fifty patients on CAPD from our department were enrolled in the study. Eight patients with residual urine volume ≤100 ml/d and 42 patients with residual urine volume ＞100 ml/d were enrolled into anuria group and non-anuric group respectively. The clinical and laboratory status of each group were compared and equations (Hoek’s, Yang’s and abbreviated MDRD equations) were validated in the non-anuric group by comparing with the arithmetic average of residual renal creatinine clearance rate and residual renal urea clearance rate which was considered as the golden standard for RRF. Results (1) Anuric group had significantly higher serum Cys C than the non-anuric group [(7.73±1.13) mg/L vs (6.46±1.15) mg/L, t＝2.39, P＝0.02)]. (2) RRF estimated by each equation was correlated well with measured RRF (r＝0.56, 0.56 and 0.39, all P＜0.05). (3) Yang’s equation [0.10 ml•min-1•(1.73 m2)-1] was least biased, followed by Hoek’s equation [-0.73 ml•min-1•(1.73 m2)-1] and abbreviated MDRD equation [3.15 ml•min-1•(1.73 m2)-1]. (4) The precision of Yang’s equation was equivalent to that of Hoek’s equation and both of them were better than abbreviated MDRD equation [6.2 and 6.1 vs 8.4 ml•min-1•(1.73 m2)-1]. (5) 50% accuracy according to Yang’s equation and Hoek’s equation revealed an elevated results in comparison to that according to abbreviated MDRD equation (59.5% and 54.8% vs 23.8%, respectively, all P＜0.01). Conclusions Serum Cys C-based prediction equations are better than the abbreviated MDRD equation in bias, precision and 50% accuracy. For patients undergoing CAPD, the use of Cys C-based equation to estimate RRF may be a clinically acceptable alternative.     

体外循环患者术后发生急性肾损伤的风险评估

目的 探讨体外循环心脏停搏手术后并发急性肾损伤（acute kidney injury,AKI）的肾脏危险因素以及不同肾小球滤过率估测值（estimated glomerular filtration rate,eGFR）水平与AKI发生率之间的关系.方法 回顾性分析793例行体外循环心脏手术成人患者的临床资料,分别统计患者术前及术后7d内血肌酐（SCr）值、术后尿量,评价有无AKI的发生.采用回归分析等统计学方法研究SCr、尿素氮（BUN）、尿酸（UA）、血尿、蛋白尿,肾脏影像学异常（包括B超、CT及ECT）等因素与AKI之间的关系.采用简化MDRD公式计算eGFR,探讨不同水平的eGFR与AKI发生率之间的关系.结果 体外循环心脏停搏术后7d内并发AKI者136例（占17.1％00）;术前蛋白尿、肾脏体积缩小或弥漫性改变,肾积水,血肌酐、尿素氮浓度增高,eGFR≤90 ml· min^-1·（1.73 m^2）^-1等因素与AKI的发生明显相关（P＜0.01）;eGFR≤90 ml·min^-1·（1.73 m^2）^-1时,术后AKI发生率升高,且二者之间呈负相关.Logistic回归分析结果显示术前蛋白尿,肾脏体积缩小或弥漫性改变,血肌酐浓度增高为术后并发AKI的独立危险因素.结论 体外循环心脏停搏术前肾脏损伤可导致术后并发AKI,临床工作中必须谨慎评估风险和认真防治.     

Estimating glomerular filtration rate in the general population: the second Health Survey of Nord-Trondelag (HUNT II).

BACKGROUND: Guidelines recommend the modification of diet in the renal disease (MDRD) formula or the Cockcroft-Gault formula for estimating the glomerular filtration rate (GFR). However, there is an ongoing discussion whether the MDRD formula should be used in the general population as several studies have found a large underestimation of its GFR estimates. METHODS: In this study, 1,029 low-risk subjects, eligible for kidney donation according to internationally accepted criteria were selected from the population-based second Health Survey of Nord-Trondelag (HUNT II). Serum creatinine values traceable to isotope dilution mass spectrometry were used with the re-expressed MDRD formula recently published. The 2.5th, 50th and 97.5th percentiles of GFR by age were calculated and compared to reference values from the literature, which are based on GFR measured with gold standard methods in potential kidney donors. RESULTS: The difference between the 50th percentiles for MDRD estimates and measured GFR in the literature was small and constant over age: +0.5 ml/min/1.73 m(2) at age 20 and -2.0 ml/min/1.73 m(2) at age 80. Bias for Cockcroft-Gault estimates varied from 0.0 ml/min/1.73 m(2) to -21.4 ml/min/1.73 m(2). Other formulae also had a too steep age correction, and bias among the elderly varied from -10 to -30 ml/min/1.73 m(2). Hence, 30-80% of the general population above age 60 had GFR estimates below their age-specific 2.5th percentile of normal kidney function, while the MDRD formula was much more conservative (13.3%). CONCLUSION: The MDRD formula gave nearly unbiased estimates for normal GFR. All other formulae tested had, especially in the elderly, a much larger negative bias and cannot be recommended for use in the general population.     

Comparison of different equations for estimated glomerular filtration rate in patients with chronic kidney disease

Objective To compare different equations for estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease (CKD). Methods Hospitalized patients with CKD from the nephrology department of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) were recruited between December 2014 and May 2015. The calculations of eGFR and 24 h creatinine clearance rate (Ccr) were accomplished in three days after admission. The eGFRs were calculated separately using the 24 h creatinine clearance rate adjusted by the standard body surface area (Ccr_BSA), Cockcroft-Gault equation adjusted by the standard body surface area (eCcr_BSA), CKD-EPI creatinine equation (EPI_Cr), CKD-EPI cystatin C equation (EPI_CysC), CKD-EPI creatinine-cystatin C equation (EPI_Cr_CysC), simplified MDRD (MDRD) and China MDRD equations. The EPI_Cr_CysC equation was used as the standard and the precision and accuracy of the other six equations were compared and analyzed. Results A total of 403 CKD participants were enrolled in the study, with 228 male patients and a mean age of (54.9±18.4) years. The main primary diseases were chronic glomerulonephritis (43.7%) and diabetic nephropathy (13.2%). The median concentration of serum creatinine and cystatin C were 117.5 (69.7, 242.4) μmol/L and 1.80 (1.13, 3.31) mg/L, respectively. The median values of Ccr_BSA, eCcr_BSA, MDRD, China MDRD, EPI_Cr, EPI_CysC and EPI_Cr_CysC equations were 50.8 (21.1, 96.2), 51.9 (23.3, 93.2), 53.6 (23.0, 97.4), 52.2 (22.4, 94.1), 53.2 (22.1, 97.3), 35.1 (15.4, 67.0) and 49.1 (22.8, 82.3) ml?min-1?(1.73 m2)-1, respectively. There was well agreement among MDRD, China MDRD and EPI_Cr equations, while there were large differences between equations derived from CysC (EPI_Cr_CysC and EPI_CysC) and equations derived only from creatinine (EPI_Cr, MDRD, China MDRD, eCcr_BSA, Ccr_BSA equations). Compared with EPI_Cr_CysC equation (the reference equation), EPI_Cr equation showed the highest accuracy [percentage of other eGFR equation calculations that were ＞30% of the reference equation calculations (1-P30), 30.8%] while Ccr_BSA equation showed the lowest (1-P30, 42.4%). EPI_CysC equation showed the highest precision [inter-quartile range (IQR) of the difference, 11.7 ml?min-1?(1.73 m2)-1] while Ccr_BSA equation showed the lowest [IQR of the difference, 22.8 ml?min-1?(1.73 m2)-1]. Conclusions The agreement among equations derived only from creatinine is better; while it exhibits some differences between equations with cystatin C and equations derived only from creatinine. The accuracy of EPI_Cr equation is second only to EPI_Cr_CysC equation and it is currently the most suitable eGFR equation for clinical popularization of renal glomerular function assessment.     

血糖水平对糖尿病患者肾小球滤过率估算公式的影响

目的 评价糖尿病患者血糖水平对肾小球滤过率（GFR）公式估算结果的影响;比较不同血糖水平Cockcroft-Gault（CG）公式和MDRD公式法估算GFR对诊断肾功能不全的差异。 方法 选取1210例糖尿病患者,同步检测99mTc-GFR（iGFR）、Scr和糖化血红蛋白（HbA1c）。运用CG和MDRD公式计算GFR估计值（eGFRCG、 eGFRMDRD）。依据肾脏病透析预后质量指南（K/DOQI）的建议将糖尿病患者分为iGFR正常组589例[NGFR组,iGFR≥90 ml&#8226;min-1&#8226;(1.73 m2)-1],iGFR轻度下降组[GGFR组,60≤iGFR<90 ml&#8226;min-1&#8226;(1.73 m2)-1]470例,iGFR中度下降组[MGFR组,30≤iGFR<60 ml&#8226;min-1&#8226;(1.73 m2)-1]151例。根据HbA1c的四分位点（7.1%,10.5%）分为4组（<7.1%、7.1%~8.6%、8.7%~10.4%、≥10.5%）,其中HbA1c<7.1%者定义为血糖控制较好组,HbA1c≥10.5%定义为血糖控制差组。采用Spearman相关分析、t检验、Bland-Altman分析、受试者工作特征（ROC）曲线等评估方程的偏离度、准确度,以及血糖对估算结果的影响。 结果 eGFRMDRD在各GFR亚组中均高估GFR;eGFRCG在NGFR组中低估GFR,差异有统计学意义。Bland-Altman分析结果显示,血糖控制较差组的eGFRMDRD的偏差高于血糖控制较好组的eGFRMDRD;血糖控制较差组的eGFRMDRD15%和30%准确性低于血糖控制较好组的eGFRMDRD,差异有统计学意义。血糖控制较差组和较好组间eGFRCG偏差及准确性差异均无统计学意义;而eGFRCG的偏差高于eGFRMDRD,差异有统计学意义。血糖控制良好组CG公式和MDRD公式在诊断肾功能不全患者的ROC曲线下面积差异无统计学意义。血糖控制较差组eGFRMDRD ROC曲线下面积显著大于eGFRCG曲线下面积,差异有统计学意义。 结论 糖尿病患者采用MDRD和CG公式法可导致GFR估计差误。MDRD公式的eGFR估计值受到血糖的影响较大,MDRD公式法高估GFR。MDRD公式在血糖控制较差的患者对肾功能不全患者的估算效应要优于CG公式。