临床常用肾小球滤过率评估方程在2型糖尿病患者中的效能比较

目的评价目前临床常用的肾小球滤过率（GFR）评估方程在2型糖尿病患者中的准确性和适用性。方法入选2007年10月至2010年12月在广州中山大学附属第三医院肾内科及内分泌科住院的2型糖尿病患者224例，其中男133例，女91例，平均年龄（60±13）岁。测定血清肌酐和胱抑素C水平，以体表面积标化的锝-二乙三胺五乙酸（^99mTcDTPA）测得的GFR（sGFR）为标准，采用肾脏病膳食改良试验方程（MDRD）、中国方程、Cockcroft—Gault方程、慢性肾脏病流行病合作组方程（EPI方程）、瑞金方程、慢性肾脏病流行病合作组胱抑素方程（EPI—Cysl方程及EPI-Cys2方程）以及MacIsaac胱抑素方程估测GFR值。应用Bland—Altman分析、线性相关分析及受试者工作特征曲线进行数据统计。结果（1）Bland—Altman分析显示，EPI—Cysl方程、EPI—Cys2方程及MacIsaac胱抑素方程估测的GFR与sGFR的一致性最好，所有方程估测的GFR与sGFR的一致性限度均超过预定的界值；EPI．Cysl方程、EPI—Cys2方程及MacIsaac胱抑素方程与x轴的斜率分别为0．168、0．183、0．186；MacIsaac胱抑素方程与Y轴的截距最小。（2）胱抑素C推导的3个方程偏差较小，30％符合率达60％以上，50％符合率达85％；EPI．Cysl方程和EPI-Cys2方程低估GFR，血肌酐推导的5个方程高估GFR。（3）诊断慢性肾病的效能方面，EPI—Cysl方程及EPI-Cys2方程的准确性和敏感度较高（分别为88％和94％），MacIsaac胱抑素方程和瑞金方程的截点值分别为62．4、64．9ml·min-1·1．73m-1，与原分割点（60ml·min-1·1．73m-2）吻合度较高。结论8个GFR方程估算的GFR均存在不同程度的误差，胱抑素C推导方程总体效能高于血肌酐推导方程，瑞金方程在血肌酐推导方程中效能较高。在今后广泛用于临床前，所有方程仍需进一步进行校正。

Comparison of effectiveness of estimated glomerular filtration rate equations in patients with type 2diabetic kidney disease

Objective To evaluate the effectiveness of estimated glomerular filtration rate （eGFR） equations in patients with type 2 diabetic kidney disease. Methods A total of 224 patients with type 2 diabetes mellitus （male 133, female 91, average age （60 ± 13 ） y） who were treated during October 2007 and December 2010 in the Third Affiliated Hospital of SUN Yat-sen University were enrolled in this study. Serum creatinine （Scr） and cystadin-C （cysC） were tested, eGFR was calculated with abbreviated Modification of Diet in Renal Disease （MDRD） equation, Chinese equation, Cockcroft-Gauh equation, Chronic Kidney Disease Epidemiology Collaboration （CKD-EPI） equation, Ruijin equation, EPI-Cysl equation, EPI-Cys2 equation and Maclsaac equation, respectively, and compared with 99mTe-DTPA-GFR （sGFR） by Bland-Ahman analysis, Pearson correlation and receiver operator characteristic （ROC） curve. Results （ 1 ） In Bland-Altman analysis, consistency of EPI-Cysl, EPI-Cys2 and Maclsaac equations with sGFR was better than other equations, and all eGFRs were above the limit point. The slopes of EPI-Cysl, EP1-Cys2 and Maelsaac equations were 0. 168, 0. 183, and 0. 186, respectively. The intercept of Maclsaae equation was smaller. （2） Bias of EPI-Cysl, EPI-Cys2 and Maclsaac equations were smaller than others. 30% or 50% accuracy rate of these three equations was above 60% and 85%. EPI-Cysl and EPI-Cys2 equations underestimated actual GFR and other Scr-based equations overestimated GFR. （3） As to diagnosis of diabetic kidney disease, EPI-Cysl and EPI-Cys2 equations were more sensitive （94%） and accurate （ 〉88% ）. The cut-point of MacIsaac and Ruijin equations were 62.4 and 64. 9 ml·min-1· 1.73 m-2, closer to 60 ml ·min-1 . 1.73 m-2. Conclusion All the equations shows bias in estimating actual GFR. Compared with the equations induced by Scr, CysC-based equations may be more accurate and efficient. All the equations should be amended when applying to patients with type 2 diabetes mellitus.