摘要
目的评价肾小球滤过率(GFR)评估方程在慢性肾脏病(CKD)患者不同分期中的适用性。方法选择近一年来在我院肾科就诊的CKD患者,将MDRD7方程、简化MDRD方程、Cockcroft Gault方程估计的GFR值用体表面积(BSA)标准化(7GFR、aGFR、cGFR),与BSA标准化的双血浆法99mTc DTPA测的GFR(sGFR)在不同CKD分期进行比较。结果入选了298例患者,男165例,女133例,年龄(52.5±15.5)岁。引发CKD的病因包括肾小球疾病、梗阻性肾病、肾动脉狭窄、慢性肾小管间质疾病、原因不明或其他疾病。在CKD不同分期,7GFR、aGFR、cGFR与sGFR均有统计学意义(P<0.001)。当sGFR<30ml·min-1·(1.73m2)-1时,7GFR、aGFR和cGFR均显著高于sGFR(P<0.05),sGFR越低,偏差越明显;当sGFR>60ml·min-1·(1.73m2)-1时,7GFR、aGFR和cGFR均显著低于sGFR(P<0.05),sGFR越高,偏差越明显。结论在CKD1、2期,7GFR、aGFR和cGFR过低估计sGFR;在CKD4、5期,过高估计sGFR。上述方程直接应用于我国CKD患者时,可能产生明显的偏差,有必要对其进行适当修正。
Objective To understand the applicability of MDRD equation in Chinese patients with chronic kidney disease(CKD). Glomerular filtration rate(GFR) estimated with MDRD equation, abbreviated MDRD equation and Cockcroft-Gault equation was compared with 99mTc-DTPA plasma clearance by dual plasma sampling method in different stages of CKD. Methods CKD were diagnosed according to K/DOQI guideline.298 patients with CKD were selected. Patients′sex,age, height and body weight were recorded and plasma creatinine, urea nitrogen and albumin were measured in a single clinical laboratory. 99mTc-DTPA plasma clearance was calculated and standardized by body surface area (sGFR). GFRs estimated with MDRD equation 7, abbreviated MDRD equation and Cockcroft-Gault equation (7GFR, aGFR and cGFR) were compared with sGFR in different stages of CKD.Results There were 165 male and 133 female in the selected 298 patients with CKD;the average age was (52.5±15.5) years.There was significant difference between the GFRs of the 3 equations with sGFR in different stages of CKD(P<0.001). 7GFR, aGFR and cGFR were significantly higher than sGFR in CKD stages 5-4;the lower the sGFR, the more the differences. 7GFR, aGFR and cGFR were significantly lower than sGFR in CKD stage 2-1;the higher the sGFR, the more the differences. Conclusion Our results showed that in Chinese population with CKD, MDRD equation 7,abbreviated MDRD equation and Cockcroft-Gault equation overestimate actual GFR in CKD stages 4-5 and underestimate GFR in CKD stages 1-2. These results indicate that MDRD equation and its modifications for estimation of GFR should be amended when applying to Chinese patients with CKD in clinical practice.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2005年第4期285-289,共5页
Chinese Journal of Internal Medicine
基金
北京大学"十五"
"211工程"重点学科建设基金资助项目(91000246156061)
