不同肾小球滤过率估算方程在术前肾癌患者中的临床应用研究

目的 评价7种不同估算肾小球滤过率(eGFR)方程在术前肾癌患者肾功能监测方面的应用价值.方法 选取2012年1月至2015年9月该院泌尿外科肾细胞癌术前住院患者386例,以99mTc2-DTPA肾动态显像测定肾小球滤过率(GFR)作为参考标准(rGFR),与7种eGFR做比较.用Spearman相关性分析和Bland-Altman一致性分析评价“金标准”GFR (rGFR)与eGFR的相关性;计算系列诊断性能指标及受试者工作特征曲线(ROC)评价各估算方程在不同影响因素下的诊断能力.结果 7种eGFR与rGFR的结果具有相关性(P均＜0.001).从诊断性能来看,eGFR1和eGFR2较好;而通过各估算方程ROC曲线发现,eGFR5、eGFR2和eGFR1的ROC曲线下面积相对较高.结论 7种eGFR方程在术前肾癌患者肾功能评价方面存在一定差异.CKD-EPI公式诊断价值最大,其次为瑞金公式,但是对于大于70岁的患者不适月.

The application of different GFR estimation equations in preoperative patients with renal cell carcinoma

Objective To evaluate the diagnostic performances of seven estimation formulas for glomerular filtration rate (GFR) in pre-operative patients with renal cell carcinoma.Methods A total of 386 pre-operative patients with renal cell carcinoma in the first affiliated hospital of Chongqing medical university from January 2012 to October 2014 were selected.All the patients' GFRs were measured by the renal dynamic imagingwith 99mTc-DTPA as reference (rGFR) and the seven GFR estimation equations (eGFR) were compared with the rGFR respectively.Their correlations and consistencies were observed with spearman correlation analysis and Bland and Altman analysis.The diagnostic sensitivity,specificity and likelihood ratios were calculated and the eGFR accuracies were assessed with receiver operator curve (ROC) analysis.Results The correlations between the rGFR and eGFRs were significantly (P＜0.001).In addition,CKD-EPI-Asian Crea and Ruijin formula were more accurate than others in different stages with larger ROC area in diagnosing renal cell carcinoma.Conclusion There were significant correlations between the eGFRs and rGFR,but some deviations existed.CKD-EPI-Asian Crea and Ruijin formula were more suitable for assessment of eGFR of pre-operative patients with renal cell carcinoma.However,both of these equations had a few limitations.