3种CKD-EPI方程估算老年慢性肾脏病患者GFR的效能比较

发布时间：2018-04-20 08:28

本文选题：肾小球滤过率 + 计算方程　；参考：《山东医药》2017年14期

【摘要】：目的评价3种慢性肾脏病流行病学合作研究组(CKD-EPI)计算方程估算老年慢性肾脏病(CKD)患者肾小球滤过率(GFR)的效能。方法选择89例老年CKD患者,以99mTc-DTPA肾动态显像法为金标准计算GFR,记录为r GFR。以患者年龄、血肌酐(Scr)及血清胱抑素C(CysC)水平为依据,分别用3种CKD-EPI方程(包括EPIScr、EPI-CysC、EPI-Scr-CysC)估算GFR,记录为e GFR。比较3种CKD-EPI方程所得e GFR与r GFR的一致性、10%及30%的准确性、精确度、绝对偏倚,分析其效能。采用Pearson相关分析及组间相关系数(ICC)评价e GFR与r GFR的一致性。以e GFR在r GFR±10%及±30%范围内的百分率评价10%及30%的准确性。以标准误差评价精确度。以e GFR与r GFR差值的绝对值评价绝对偏倚。结果 (1)一致性:总体人群、男性人群及女性人群中,EPI-CysC及EPI-Scr-CysC的ICC均高于EPI-Scr。男性人群中EPI-CysC达到良好级别(ICC=0.773)、EPI-Scr-CysC(ICC=0.746)接近良好级别。在全部人群、男性人群及女性人群中,3种CKD-EPI方程与r GFR的相关性由大到小均为EPI-CysCEPI-Scr-CysCEPI-Scr。(2)准确性:P10方面,女性人群中3种CKD-EPI方程差异有统计学意义(P0.05),其中EPI-Scr与EPI-Scr-CysC的差异有统计学意义(P0.05),EPI-Scr在不同性别中的差异均有统计学意义(P0.01);P30方面,在全部人群及女性人群中,EPI-Scr与EPI-CysC及EPI-Scr-CysC间的差异均有统计学意义(P均0.05),EPI-Scr在不同性别中的差异有统计学意义(P均0.01)。(3)精确度:全部人群、男性人群及女性人群中,EPI-Scr-CysC的标准误差均最低,精确度均最高。(4)绝对偏倚:全部人群中,EPI-Scr的绝对偏倚大于EPICysC及EPI-Scr-CysC(P均0.05)。女性人群中,EPI-Scr的绝对偏倚大于EPI-CysC及EPI-Scr-CysC(P均0.05)。EPI-Scr方程在不同性别中的绝对偏倚差异有统计学意义(P0.01)。结论在老年尤其是女性CKD人群中,EPI-CysC及EPI-Scr-CysC方程比EPI-Scr方程更适用。
[Abstract]:Objective to evaluate the efficacy of three CKD-EPI equations in estimating glomerular filtration rate (GFR) in elderly patients with chronic kidney disease (CKD). Methods Eighty-nine elderly patients with CKD were studied by 99mTc-DTPA renal dynamic imaging as gold standard. The results were recorded as r GFR. According to the patient's age, serum creatinine creatinine (creatinine) and serum cystatin (cystatin) levels, three CKD-EPI equations (including EPIScran EPI-CysCe EPI-Scr-CysC) were used to estimate GFRs, which were recorded as e GFR. The accuracy, accuracy and absolute bias of e GFR and r GFR obtained from three CKD-EPI equations were compared by 10% and 30%, and their effectiveness was analyzed. The consistency of e GFR and r GFR was evaluated by Pearson correlation analysis and intergroup correlation coefficient. The accuracy of 10% and 30% of e GFR in the range of r GFR 卤10% and 卤30% was evaluated. The accuracy is evaluated by standard error. Absolute bias was evaluated by the absolute value of the difference between e GFR and r GFR. Results 1) consistency: the ICC of EPI-CysC and EPI-Scr-CysC in population, male and female were higher than those in EPI-Scr. In male population, the EPI-CysC reached good grade (EPI-Scr-CysCy ICC0. 746) and was close to good grade. The correlation between the three CKD-EPI equations and r GFR was EPI-CysCEPI-Scr-CysCEPI-Scr.2) accuracy: P10 in the whole population, male population and female population. There were significant differences among the three CKD-EPI equations in female population (P 0.05), and the difference between EPI-Scr and EPI-Scr-CysC was significant (P 0.05). There were significant differences in EPI-SCR between different genders (P 0.01) and P30 (P 0.01). There were significant differences among EPI-SCR, EPI-CysC and EPI-Scr-CysC in all population and female population. The accuracy of EPI-Scr in different sex was 0.05. The accuracy of EPI-Scr was the lowest in all population, male population and female population, and the standard error of EPI-Scr-CysC was the lowest in all population, male population and female population. The absolute bias of EPI-SCR was higher than that of EPICysC and EPI-Scr-CysC(P. The absolute bias of EPI-SCR in female population was higher than that of 0.05).EPI-Scr equation of EPI-CysC and EPI-Scr-CysC(P in different sex. Conclusion EPI-CysC and EPI-Scr-CysC equation are more suitable than EPI-Scr equation in the elderly, especially in female CKD population.
【作者单位】：南京中医药大学附属医院江苏省中医院;
【分类号】：R692

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