不同肾小球滤过率预估公式的评价

目的 将四个研究团队(Macisaac、Perkins、Rule、Stevens)的Cys C为变量估算肾小球滤过率(eGFR)公式,与以肌酐为变量之一的简化肾脏病膳食改善方程(MDRD)比较,在2型糖尿病人群肾脏损害各个阶段中,单独或联合应用,是否更能改进eGFR的准确性.方法 检测213例2型糖尿病患者的血清肌酐和Cys C,并运用六个不同的公式作eGFR.结果 六个预估公式均呈正态分布;在GFR的五个临床分期中,均数间多重比较,1、2、3期差异有统计学意义(P＜0.01);以MDRD方程为基准,比较以Cys C为变量的五个估算公式,1、2期Perkins和Macisaac的预估公式值大于MDRD值,3期中Steven的2个估算公式值接近.结论 2型糖尿病人群不同GFR临床分期,基于Cys C和Cr所作预估公式间有不同变化,相同趋势,两者可以互相参考和补充;在1、2期中,Cys C预估公式可能优于Cr.建议在标准化Cys C检测的基础上,扩大研究人群,建立全段和各个分期内eGFR的预估公式.

Evaluation of different estimation formulas of glomerular filtration rate

Objective To compare the performance of estimation formulas of glomerular filtration reate(eGFR) of four different investigator teams(Macisaac、Perkins、Rule、Stevens) based on Cystatin C(Cys C) with the modification of diet in renal disease (MDRD) equation based on creatinine to analyze whether the accuracy of them,when be alone or jointly used for evaluating eGFR in patients with type 2 diabetes at different stages of kidney injury.Methods 213 cases of patients with type 2 diabetes were enrolled and measured for serum Cys C and creatinine,and eGFR was evaluated by six different equations.Results The six estimation formulas were all with normal distribution,and multiple comparison of means indicated that,among the five clinical stages of GFR,there were significantly different between stage 1,2 and 3 (P<0.01).Comparison of the five equations taking Cys C as variance,when MDRD equation was taken as reference,indicated that,of stage 1 and 2,the estimated value of Perkins and Macisaac equation were higher than MDRD and of 3 value,the estimated value of the two Steven equations were close.Conclusion There could be difference between formulas based on Cys C and creatinie for patients with type 2 diabetes mellitus at different clinical stages of GFR,but with same tendency,indicating that the two different equations could be reference and supplement for each other.For stage 1 and 2,estimation equations,based on Cys C,might have more advantages than equations,based on creatinie.It could be suggested that eGFR estimation equations should be established by expanding the research populations on the basis of standard detection procedure of Cys C.