摘要
目的评估肾脏病改变饮食试验(MDRD)方程在中国糖尿病人群中的临床适用性。方法使用^(99m)Tc-DTPA 直接检测463例(女219例,男244例,年龄14～88岁)中国糖尿病人群的肾小球滤过率(GFR),并检测其血清肌酐(Scr)及半胱氨酸蛋白酶抑制剂(Cys C)浓度。以 MDRD 方程为基础与直接检测 GFR 比较,评估其在中国糖尿病人群中适用性,估算人种调整系数并与 MDRD 方程、国内改良 MDRD 方程比较;了解 Scr 及 Sys C 方法学因素对于估算 GFR 的影响;尝试建立以 Cys C为基础的 GFR 估算公式;比较 Scr 及 Cys C 的临床适用性。结果 Scr 及 Cys C 检测值倒数与放射性核素测量 GFR 检测值呈线性关系(r=0.69;r=0.83);Scr 估算方程为 GFR[ml·(min·1.73m^2)^(-1)]=175×(Scr)^(-1.154)×(age)^(-0.203)×0.742(女性)×0.827(0.827为中国人群的人种系数)。含此系数的 MDRD 公式估算 GFR 的临床诊断性能曲线(ROC曲线)下面积0.818,优于文献报道的 MDRD 方程(0.644)及国内改良 MDRD 方程(0.709)。散射法检测 Cys C 估算方程为 GFR[ml·(min·1.73m^2)^(-1)]=63.24×(Cys C)^(-0.3378);透射法检测 Sys C 估算方程为 GFR[ml·(min·1.73 m^2)^(-1)]=59.02×(Cys C)^(-0.3880)。使用 Cys C 估算 GFR 在60岁以上人群优于 Scr 估算的 GFR(ROC 曲线下面积0.722与0.583)。方法学差异影响 GFR 估算,罗氏酶法 Scr 检测试剂结果可溯源至同位素稀释质谱法(IDMS),明显低于苦味酸法 Scr 检测(Y=0.94X-0.02)。如使用未溯源至 IDMS 的苦味酸法 Scr试剂,应将方法学系数调整为186。结论临床实验室报告估算 GFR 值,可使用 Scr 或 Cys C 抑制剂。使用 Scr 估算 GFR 应使用可溯源至 IDMS 的肌酐检测结果,并考虑人种因素。
Objective To assess the applicability of the Modification of Diet in Renal Disease （MDRD） formula to kidney function impaired Chinese diabetic patients. Methods Glomerular filtration rates （GFRs） in 463 Chinese diabetic patients （219 female, 244 male, aged 14 to 88） were estimated by measuring ^99mTc-DTPA clearance and with equations based on serum creatinine （Scr） and cystatin C （ Cys C） concentrations. GFRs derived from various equations were compared with the ^99mTc-DTPA clearance GFRs and their relative accuracies were assessed with ROC analysis. All the Scr measurements were performed with beth the Roche enzymatic assay and the Beckman LX20 kinetic alkaline picrate assay, and Cys C with immanonephelometric and immunoturbidimetric assays. Results The reciprocals of Cys C and Scr were linearly correlated with ^99mTc-DTPA clearance GFRs （ r = 0. 830 and 0. 690, repectively ）. The correlation of GFR with Scr could be expressed by an adjusted MDRD equation ： GFR [ ml·（ min·1. 73 m^2 ）^-1 ] = 175×（Scr）^-1. 154×（age）^-0.203×0. 742 （female）×0. 827, where 0. 827 was a coefficient for Chinese. The adjusted equation showed a better accuracy than the MDRD equation （ areas under the ROC curve 0. 818 vs 0. 644）. The adjusted equation was also more accurate than equations obtained in previous Chinese studies. GFRs were also estimated by using Cys （in mg/L） with the following equation： GFR [ ml·（ min·1. 73 m^2 ）^-1 ] = 63. 24×（ Cys C）^-0. 3378. The accuracy of the Cys equation was similar to the Scr equation, or better in patients aged 60 and above. The Roche enzymatic results which were traceable to the isotope dilution mass spectrometry （IDMS） methods were significantly lower than Beckman LX20 results, but the results were closely correlated with each other （ Y = 0. 94X - 0. 02 ）. When non-traceable Scr results were used,the coefficient needed to be adjusted. Conclusions GFRs can be estimated with equations based on either Scr or Cys C. GFR estimation should use standardized Scr results and take into account ethnic effects.
出处
《中华检验医学杂志》
CAS
CSCD
北大核心
2007年第11期1214-1218,共5页
Chinese Journal of Laboratory Medicine
