活体供者供肾前后肾功能评价指标的临床适用性比较

目的 探讨适用于活体供者供肾前后肾功能评价的简单易行的方法.方法 以供肾切取术前、术后早期(7～10 d)和术后稳定期(1年左右)3个阶段用~(99m)锝-二乙烯三胺五乙酸肾动态显像法(Gates法)测得的肾小球滤过率(gGFR)为标准,评价46名供者同期血清胱抑素C水平、Cockcroft-Gault公式所得肌酐清除率(cCCr)、24 h集尿法所得肌酐清除率(uCCr)、MDRD方程所得肾小球滤过率(mGFR)和血清肌酐(SCr)等简易肾功能评估方法的临床适用性,所得结果采用体表面积进行标准化.供者术前的gGFR>1.167 ml/s(70 ml/min).结果 术后1年时,有25名供者未能完成包括gGFR在内的全部检测;由于24 h尿液留取较为复杂,共有8个样本不合格,uCCr取同期该组数据平均值.上述肾功能指标在手术前后均有明显变化,反映肾功能的各指标均为正态分布,除SCr外,其他指标与gGFR均有显著相关性(P<0.05),其相关系数(r)从高到低依次为r_(cCCr)、r_(mGFR)、r_(胱抑素C)、r_(uCCr),决定系数(R~2))同样表现为R_(cCCr)~2>R_(mGFR)~2>R_(胱抑素C)~2 >R_(uCCr)~2,术后早期和术后稳定期结果完全相同,且相比术前,术后cCCr与gGFR的相关性更为显著.结论 Cockcroft-Gault公式是相对准确的供者肾功能评价方法,特别适用于术后随访时应用,而SCr只能做为基础指标,不能作为直接评价指标.

Clinical applicability of the different indexes for renal function of living kidney donors before and after donation

Objective To explore the most adequate and simple method for evaluating the renal function of living kidney donor before and after nephrectomy. Methods Forty-six cases were enrolled in this study. At 3 stages of predonation, earlier period post-donation (7-10 days) and stable phase post-donation (1 year), by using renal dynamic imaging (Gates method) as reference standard (gGFR), clinical applicability .of cystatainc, Scr and GFR estimated by Cockcroft-Gault equation (cCCr), 24-h urine (uCCr) or MDRD equation (mGFR) were evaluated. The GFR or CCr was standardized by BSA. Before donation gGFR of every donor was more than 1.67 ml/s (70 ml/min).Results One year post-donation 25 donors couldn't finished all examinations including gGFR.Because it is difficult to collect urine in 24 h (8 unacceptable samples), we used average of uCCr in the same stage. All of these indexes which were of normal distribution changed significantly before and after nephrectomy. All outcomes of renal function were significantly correlated with gGFR except SCr, and at the 3 stages it was found that r_(CCr0 > r_(mGFR) > r_(cystatinc) > r_(uCCr), and R_(cCCr)~2 > R_(mGF)~2 > R_(cystatinc)~2 > R_(uCCr)~2. Particularly, the correlation between cCCr and gGFR was more significant post-operation.Conclusion Cockcroft-Gault equation is a relative pragmatic method for evaluating the renal function of living kidney donor, especially during the follow-up period postd-onation. SCr is a basic index which can't be used directly.