慢性肾脏病流行病合作工作组方程和肌酐全年龄段方程用于成人慢性肾脏病

目的比较慢性肾脏病流行病合作组方程(CKD-EPI)和肌酐全年龄段方程(FAS)评估慢性肾脏病(CKD)患者肾小球滤过率(GFR)的价值。方法回顾性分析393例CKD,以99 Tc m-DTPA肾动态显像法所测GFR(Tc-GFR)为金标准,采用3个CKD-EPI方程及3个FAS方程,分别为流行病学-血肌酐(EPI-SCr)、流行病学-胱抑素C(EPI-Cys-C)、流行病学-血肌酐联合胱抑素C(EPI-SCr-Cys-C)、FAS-血肌酐(FAS-SCr)、FAS-胱抑素C(FAS-Cys-C)和FAS-血肌酐联合胱抑素C(FAS-SCr-Cys-C)方程计算GFR(eGFR),比较其eGFR与Tc-GFR差异、相关性、方程偏倚,观察方程评价CKD患者GFR水平的适用性、敏感度、特异度、准确率及精确度等。结果①总样本中FAS-SCr-Cys-C偏倚最小、精确度最好,FAS-Cys-C和FAS-SCr次之,EPI-SCr偏倚最大、精确度最差;②FAS-Cys-C在P10和P30准确率最高,FAS-SCr-Cys-C次之,EPI-SCr最低;③方程曲线下面积(AUC)依次为FAS-SCr-Cys-C>EPI-SCr-Cys-C>FAS-Cys-C>EPI-Cys-C>FAS-SCr>EPI-SCr;FAS-SCr-Cys-C的AUC最大,为0.94195%CI(0.909,0.973),P<0.001],eGFR截断值取41.71 ml/(min·1.73 m 2)时,阳性预测值为98.0%,阴性预测值为51.3%,敏感度为83.3%,特异度为92.3%,约登指数为0.756;EPI-SCr-Cys-C敏感度最高(89.0%),阳性预测值略低于FAS-SCr-Cys;EPI-SCr的AUC最小,敏感度最低。结论FAS-SCr-Cys-C方程可用于测定CKD患者各期GFR。

Chronic kidney disease epidemiology equation and full age spectrum equation in adults with chronic kidney disease

Objective To compare the chronic kidney disease epidemiology equation(CKD-EPI)and full age spectrum equation(FAS)for evaluation on glomerular filtration rate(GFR)in patients with chronic kidney disease(CKD).Methods Data of 393 CKD patients were retrospectively analyzed.Taken GFR measured with 99 Tc m-DTPA renal dynamic imaging(Tc-GFR)as gold standard,3 CKD-EPI and 3 FAS equations,including epidemiology-serum creatinine(EPI-SCr),epidemiology-cystatin C(EPI-Cys-C),epidemiology-serum creatinine-cystatin C(EPI-SCr-Cys-C),FAS-serum creatinine(FAS-SCr),FAS-cystatin C(FAS-Cys-C)and FAS-serum creatinine-cystatin C(FAS-SCr-Cys-C)were used to calculate GFR(eGFR),respectively.The difference,correlation and bias of eGFR and Tc-GFR calculated by each equation were compared,and the applicability,sensitivity,specificity,accuracy and accuracy of GFR level in CKD patients were compared among 6 equations.Results①For all 393 CKD patients,the bias of FAS-SCr-Cys-C was the smallest,and the accuracy was the best,followed by FAS-Cys-C and FAS-SCr,while the bias of EPI-SCr was the largest and the accuracy was the worst.②The accuracy of FAS-Cys-C was the highest in P10 and P30,followed by that of FAS-SCr-Cys-C,of EPI-SCr was the worst.③The area under the curve(AUC)of 6 equations was in order of FAS-SCr-Cys-C>EPI-SCr-CysC>FAS-Cys-C>EPI-Cys-C>FAS-SCr>EPI-SCr;AUC of FAS-SCr-Cys-C was 0.941(the largest one,95%CI0.909,0.973],P<0.001).Taken 41.71 ml/(min·1.73 m 2)as the cut-off value of eGFR,the positive predictive value was 98.0%,negative predictive value was 51.3%,the sensitivity was 83.3%and specificity was 92.3%,and the Youden index was 0.756.EPI-SCr-Cys-C had the highest sensitivity(89.0%),and its positive predictive value was slightly lower than that of FAS-SCr-Cys.AUC and sensitivity of EPI-SCr were the lowest.Conclusion FAS-SCr-Cys-C equation could be used to measure GFR in patients with various CKD stages.