不同eGFR方程在糖尿病慢性肾脏疾病危险分层中的价值

目的 探讨不同肾小球滤过率(GFR)估算值(eGFR)计算方程在糖尿病慢性肾脏疾病危险分层中的价值。方法 收集601例糖尿病患者的病例资料，检测血中胱抑素C（Cys-C）、尿素氮（BUN）、肌酐（Scr）、尿酸（UA）、糖化血红蛋白（HbA1c）、尿中白蛋白、肌酐，计算尿白蛋白肌酐比值（ACR），利用简化的MDRD公式、eGFR-EPIcrea、eGFR-EPIcys、eGFR-EPIcrea-cys估算GFR。按尿ACR分为正常蛋白尿组、微量蛋白尿组、大量蛋白尿组，比较各组代谢指标差异，按照ACR和4种eGFR计算公式计算结果对患者进行危险度分层，分析采用各方程对危险度分层的人数分布，比较各计算公式间不同危险度患者的eGFR水平。结果 收缩压、Cys-C、eGFR-MDRD、eGFR-EPIcrea、eGFR-EPIcys、eGFR-EPIcrea-cys在3组间差异均有统计学意义（P<0.05）。用不同方程评价危险度后的人数分布存在差异，eGFR-MDRD(P<0.05)、eGFR-EPIcrea(P=0.000)分别与eGFR-EPIcys比较，在不同危险分层中的人数分布存在差异；而eGFR-MDRD、eGFR-EPIcrea、eGFR-EPIcrea-cys在不同危险分层中的人数分布无差异。在低度危险患者中，各方程估计的GFR差异较大，eGFR-MDRD较其他方程的eGFR高（P<0.05）；在中、高危患者中，eGFR-MDRD和eGFR-EPIcrea的eGFR相当，均高于eGFR-EPIcys和eGFR-EPIcrea-cys估计的GFR；在极高危患者中，4种公式估算的eGFR无差异。结论 不同方程估算的eGFR在糖尿病慢性肾脏疾病危险分层中存在差异，在低危患者中MDRD公式可能高估了GFR水平。

Risk Stratification of Diabetic Chronic Kidney Disease Using eGFR Equations

Objective?To compare different eGFR equations for risk stratification of diabetic chronic kidney disease．Methods?A total of 601 diabetic patients participated in the study. Data about the patient serum cystatin C (Cys-C), blood urea nitrogen (BUN), creatinine (Scr), uric acid (UA), glycosylated hemoglobin (HbAlc), and urinary albumin creatinine ratio (ACR) were extracted. Simplified MDRD formula were used for calculating glomerular filtration rate (eGFR) using eGFR-EPI_crea,eGFR-EPI_cys and eeGFR-EPI_crea-cys. The patients were divided into three groups according to their urine ACR. Comparisons were made between the groups of patients in Cys-C, BUN, UA, eGFR and Scr. Results?There were significant differences (P<0.05) in Cys-C, eGFR-MDRD,eGFR-EPI_crea, eGFR-EPI_cys, and eGFR-EPI_crea-cys among the groups of patients. The different equations for risk stratification produced different distributions of patients among the three groups. Significant differences appeared among the groups in the distribution of patients using eGFR-MDRD (P<0.05), eGFR-EPI_crea (P=0.000) and eGFR-EPI_cys (P<0.05) and indication for stratification. No significant differences were found in the distribution of patient among the three groups (P＞0.05) using GFR-MDRD, eGFR-EPI_crea and eGFR-EPI_crea-cys as an indication for stratification．In low risk patients, eGFR-MDRD was higher than other eGFR (P<0.05). In medium- and high-risk patients, eGFR-MDRD and eGFR-EPI_crea were higher than eGFR-EPI_cys and eGFR-EPI_crea-cys. In very high-risk patients, the four eGFR did not show differences. Conclusion?The performance of different eGFR equations differs in risk stratification of diabetic chronic kidney disease. In low-risk patients, MDRD equation may overestimate GFR level.