简化肾脏病膳食改良试验公式在血清肌酐值正常的老年男性群体中的应用

目的：探讨血清肌酐（SCr）正常的老年男性人群SCr值与经肾脏病膳食改良试验（MDRD）公式估算的肾小球滤过率（GFR）的关系。方法：应用简化MDRD公式估算818名门诊体检、SCr正常的老年男性的GFR,将其按估算GFR值GFR〈60mL/（min·1.73m^2）、60～89mL/（min·1.73m^2）、≥90mL/（min·1.73m^2）]进行分组,比较各组间年龄、体重、体重指数（BMI）、腰臀比（WHR）等,结果发现年龄、伴随疾病在不同GFR估算值组中的差异有统计学意义;再将体检者按年龄、伴随疾病分组,并应用线性回归及ROC曲线分析SCr值与GFR估算值的关系。结果：应用简化MDRD公式估算GFR发现,818名体检者中有53人（6.5%）GFR呈中度下降,均值为（57±2）mL/（min·1.73m^2）,他们平均年龄较大,为（79±6）岁,SCr值较高,为（112±6）μmol/L。按年龄分组中,SCr水平在60～69岁组与70岁以上组比较,差异有统计学意义（P〈0.05）;按伴随疾病及年龄分组,≥70岁的人群伴高血压合并2型糖尿病的患病率达39.2%,而60～69岁的人群则为15.0%。在无高血压、糖尿病高危因素的人群中,SCr值为109.5μmol/L时,经ROC曲线计算,诊断GFR异常的灵敏度为100%,误诊率为3.1%;合并高危因素人群（年龄≥70岁同时合并2型糖尿病、高血压）,SCr值为108.5μmol/L时,诊断GFR异常的灵敏度为100%,误诊率为3.2%。结论：年龄≥70岁合并慢性肾脏疾病（CKD）高危因素（如高血压、2型糖尿病）的老年男性人群,当SCr值为正常高值时（108.5μmol/L）,采用MDRD公式估算的GFR可能有异常,本研究方法可用于早期筛查CKD患者。

Application of MDRD formula in old men with normal serum creatinine level

Objective To appraise the correlation between serum creatinine （SCr） level and estimated glomerular filtration rate （GFR） in a population with normal SCr. Methods The simplified Modification of Diet in Renal Disease （MDRD） formula was used to estimate GFR. Eight hundrad and eighteen subjects were divided into subgroups by their levels of estimated GFR GFR：〈60 mL/（min· 1.73 m^2）, 60-89 mL/（min·1.73 m^2）, ≥90 mL/（min·1.73 m^2）] and their ages （60-69 years, and ≥ 70 years）. Linear regression and ROC curve were applied to analyze the correlation between SCr and estimated GFR and compare the difference among the subgroups. Results Of the 818 subjects examined, 53 （6.5%） subjects had a moderate reduced GFR 〈60 mL/（min·1.73 m^2）, mean （57±2） mL/（min·1.73 m^2） and higher SCr（112±6） μmol/L], with an average age （79±6） years. SCr levels were higher in group 〉170 years old than that in group 〈70 years old （P〈0.05）. In subjects ≥70 years old, the prevalence of hypertension and type 2 diabetes was 39.2%, while in subjects below 70 years old was 15.0%. In subjects without hypertension and type 2 diabetes, the sensitivity of SCr 109.5 μmol/L in diagnosing chronic kidney disease （CKD） was 100%, and the misdiagnosis rate was 3.1%. In subjects （aged ≥70 years） with these two risk factors, the sensitivity of SCr 108.5 μmol/L in diagnosing CKD was 100% and the misdiagnosis rate was 3.2%. Conclusions In subjects aged 〉170 years and with high risk factors of chronic kidney disease （such as hypertension, type 2 diabetes）, SCr at high limit of normal value （108.5 μmol/L） in association with GFR estimated by simplified MDRD formula could help the early detection of chronic kidney disease.