摘要
目的评价慢性肾脏疾病流行病学协作组（CKD-EPI）公式、中国eGFR协作组公式和FQ-eGFR公式计算的估算肾小球滤过率（eGFR）在慢性肾病（CKD）中的早期诊断性能。方法测定283例住院成人CKD患者和9 307例门诊成人就诊者血清中半胱氨酸蛋白酶抑制剂C（Cys C）和肌酐（Cr）水平,计算3个CKD-EPI公式（Cr-、CysC-和CysC-C联合公式）、2个eGFR协作组公式（Cys C-和CysC-C联合公式）和2个FQ-eGFR公式（Cys C-和Cys C-C联合公式）的eGFR,依次得到eGFR1~eGFR7。住院患者同时测定血浆99m锝-二乙烯三胺五乙酸（99mTc-DTPA）清除率[作为测量GFR（mGFR）],用于其eGFR差异性、一致性以及分析性能评价的金标准。然后回顾性分析了9 307例门诊成人就诊者中各eGFR预测CKD的相对发生率（IRR）。结果 eGFR2、eGFR3与mGFR比较差异均有统计学意义（P均=0.000）。eGFR4、eGFR6和eGFR7与mGFR的一致性相关系数（ρc）值均明显高于eGFR1（P均〈0.01）。对于mGFR〈60 m L/（min·1.73 m^2）患者,eGFR4、eGFR6和eGFR7的偏差、精密度和准确性无差异（P均〉0.05）,但与eGFR1比较差异均有统计学意义（P均〈0.05）。相比之下,eGFR4的偏差更小[中位数（M）=0.3 m L/（min·1.73 m^2）],eGFR6的精密度更高[标准四分位距（IQR）=7.7m L/（min·1.73 m^2）],eGFR7的准确性更好（1-P30=13.8%）。应用eGFR4、eGFR6和eGFR7预测CKD的发生率高于eGFR1（P均〈0.01）,且年长者（〉65岁）与65岁以下者相比其预测CKD发生率更高（P均=0.000）。结论对于GFR〈60 m L/（min·1.73 m^2）的中国成人CKD患者,CKD-EPI公式并不能提供更为准确的肾功能评估。相对而言,中国eGFR协作组Cys C公式、FQ-eGFR CysC公式或FQ-eGFR CysC-C联合公式更适用于中国成人CKD的疾病筛查和早期诊断,其中FQ-eGFR CysC公式用于疾病筛查可尽可能地避免漏诊或误诊。
Objective To evaluate the performance of chronic kidney disease epidemiology collaboration（ CKDEPI） equations,Chinese estimated glomerular filtration rate（ eGFR） investigation collaboration equations and FQ-eGFR equations in the early diagnosis of chronic kidney disease（ CKD）. Methods Serum cystatin C（ CysC） and creatinine（ Cr） concentrations were detected in 283 inpatients with CKD and 9 307 outpatients,and the eGFR of 3 CKD-EPI equations（ Cr-,CysC-and CysC-C equations）,2 Chinese eGFR investigation collaboration equations（ CysC-and CysC-C equations） and 2 FQ-eGFR equations（ CysC-and CysC-C equations） were calculated as the order of eGFR1-eGFR7. Plasma99mtechnetium-diethylene triamine pentacetic acid（99mTC-DTPA） clearance rate as measured glomerular filtration rate（ mGFR） was detected in 283 inpatients with CKD,and was used as a gold standard for evaluating difference,consistency and performance of eGFR. The incidence rate ratio（ IRR） of each eGFR predicting CKD was analyzed retrospectively in 9 307 outpatients. Results There were significant differences between eGFR2 and eGFR3 with mGFR（ P = 0. 000）. The concordance correlation coefficients（ ρc） of eGFR4,eGFR6 and eGFR7 with mGFR were all significantly higher than that of eGFR1（ P〈0. 01）. For the patients with mGFR 60 m L /（ min ·1. 73 m2）,the deviation,precision and accuracy of eGFR4,eGFR6 and eGFR7 had quite correspondence（ P〈0. 05）,and had significant differences with those of eGFR1（ P〈0. 05）. In contrast,the deviation of eGFR4 was smaller [median（ M）= 0. 3 m L /（ min · 1. 73 m^2） ],the precision of eGFR6 was higher [standard interquartile range（ IQR） =7. 7 m L /（ min·1. 73 m2） ],and the accuracy of eGFR7 was better（ 1-P30= 13. 8%）. The incidence rates of predicting CKD by eGFR4,eGFR6 and eGFR7 were higher than that by eGFR1（ P〈0. 01）,and were greatly higher in elderly（ 65 years old） compared with in under 65 years old（ P = 0. 000）. Conclusions CKD-EPI equations could not provide an accurate assessment of kidney function for Chinese adult patients with CKD, whoseGFR 60 m L /（ min·1. 73 m^2）. In contrast,it would be more appropriate for the screening of diseases and early diagnosing used CysC-equation,FQ-eGFR CysC-equation or FQ-eGFR CysC-C equation of Chinese eGFR investigation collaboration equations,in which it is as far as possible to prevent leak-diagnosis or misdiagnosis when FQ-eGFR CysCequation is used for the screening of diseases.
出处
《检验医学》
CAS
2015年第7期684-690,共7页
Laboratory Medicine
关键词
估算肾小球滤过率
肾小球滤过率
早期诊断
慢性肾病
Estimated glomerular filtration rate
Glomerular filtration rate
Early diagnosis
Chronic kidney disease
