目的 研究不同的基于血肌酐估测肾小球滤过率(eGFR)公式对健康成年人肾功能的评价.方法 本研究为横断面研究.选取2009年1月至2011年12月存山东大学附属千佛山医院健康管理中心查体的841名健康成年人,应用CKD-EPI两种族及四种族公式、中国人校正的MDRD公式(Chi-MDRD)、简化MDRD公式估测eGFR.应用Skewness偏度和Kurtosis峰度评估eGFR的分布,并用Bland-Altman曲线进行一致性检验,Kappa检验判断不同公式对eGFR分期的一致性.结果 CKD-EPI两种族及四种族公式的eGFR(Skewness偏度分别为0.11和0.12,Kurtosis峰度分别为-0.41和-0.37)比Chi-MDRD公式和简化MDRD公式的eGFR(Skewness偏度分别为1.63和1.67,Kurtosis峰度分别为5.22和5.73)更趋于正态分布.在eGFR范围为60～89ml·min-1·(1.73 m2)-1的肾功能下降组,应用简化MDRD公式有51.5％ (433/841)的研究对象被划分为“肾功能下降组”；在eGFR≥150 ml·min-1·(1.73 m2)-1的高滤过组,应用Chi-MDRD公式有4.3％(36/841)的研究对象被划分为“高滤过组”.CKD-EPI两种族及四种族公式eGFR一致性好,但CKD-EPI两种族eGFR比四种族eGFR平均低5.3 ml·min-1·(1.73 m2)-1.CKD-EPI两种族及四种族公式在eGFR≥150,120 ～149,90 ～119,60～89 ml·min-1·(1.73 m2)-1组的符合率分别为25.0％(1/4)、52.5％(94/179)、86.5％(453/524)和100％(134/134)(Kappa=0.65,95％CI:0.62 ～0.68),提示两公式的eGFR的分期一致性好.结论 与Chi-MDRD公式及简化MDRD公式相比较,CKD-EPI两种族及四种族公式的eGFR分布更合理,且2个公式对eGFR的估测表现相似.%Objective To evaluate of four equations based on serum creatinine to estimate glomerular filtration rate (eGFR) in a healthy adult population.Methods A cross-sectional study of 841 Chinese healthy adults who visited the Health checkup Clinic consecutively in our hospital were enrolled.eGFRs were calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) two-level race equation,the CKD-EPI four-level race equation,the Modification of Diet in Renal Disease (MDRD) equation and the Chinese modification of the MDRD Study equation (Chincsc equation),respectively.The Bland-Altman method and Kappa test were used for comparing the agreement between two different equations to eatimate GFR.Results The CKD-EPI two-level race and the four-level race equation showed a Gaussian distribution compared with the Chinese equation and the MDRD equation,whose Skewness were 0.11 and 0.12 versus 1.63 and 1.67,the Kurtosis were-0.41 and-0.37 versus 5.22 and 5.73,respectively.The MDRD equation made the percentage of eGFR 60-89 ml · min-1 · (1.73 m2)-151.5％ (433/841) and the Chinese equation made the percentage of eGFR ≥150 ml · min-1 · (1.73 m22)-14.3％ (36/841),respectively.Mean eGFR was 5.3 ml · min-1 · (1.73 m2)-1 lower with the CKD-EPI two-level race equation as compared to the CKD-EPI four-level race equation.The percentage of GFR staging concordance between the CKD-EPl two-level race and the four-level race equations for eGFR ≥ 150,120-149,90-119,60-89ml · min-1 · (1.73m2)-1was25.0％ (1/4),52.5％ (94/179),86.5％ (453/524),and 100％ (134/134),respectively.Kappa index was 0.65 and the 95％ confidence interval was 0.62 to 0.68.Conclusions The CKD-EPI two-level race equation and the four-level race equation perform similarly,and both of them seem to eatimate a reasonable distribution of eGFR in Chinese healthy adult population.
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