GFR评估方程在不同人群中应用的一致性评价

摘要

目的 采用pearson相关分析、Bland-Altman图及Bradley-Blackwood检验评价Cockcroft-Gault 方程(CG方程)和MDRD方程5估算肾小球滤过率(GFR)的相关性和一致性.方法 依据患者资料和临床诊断将纳入人群分为4组:健康人组、老年人组、单纯肥胖组和慢性肾脏病(CKD)组.碱性苦味酸法测定血清肌酐,CG方程和MDRD方程5计算GFR,在各组的估算结果 间进行简单相关分析和Bland-Altman分析,绘制一致性限度(limits of agreement)作为评价一致性的指标.同时,采用相同方法评价当血清肌酐水平发生较大变化时,两方程估算值变化的一致性.结果 两方程在不同人群的GFR估算值具有线性相关关系;Bland-Altman分析表明,不同人群中,两方程估算结果 差值具有临床意义,其估算GFR的一致性较差.并且,在病情发生变化时,运用不同方程估算GFR变化量间的差异不能被临床接受,一致性差.结论 CG方程和MDRD方程5估算GFR的一致性较差,估算结果 不具有等价性、可替代性,但估算值间具有相关性.%Objective To assess the agreement of estimated GFR(eGFR) ,determined by CG equation and MDRD equation 5 in different populations. Methods According to clinical documents and diagnosis,enrolled subjects were divided into four groups. Serum creatinine was detected by picric acid method, estimated GFR was determined by CG equation and MDRD equation 5 recommended by Chinese eGFR Investigation Collaboration. Bland-Altman analysis and Pearson s correlation analysis were performed to evaluate the relationships between the eGFR in same group. In Bland-Altman plot,the agreement of two equations was decided by the limits of agreement. The cases that serum creatinine changed significantly were collected. The changes of eGFR caused by the changes of serum creatinine were analyzed by Bland-Altman plot and Pearson s correlation analysis. Results Pearson s correlation analysis showed that the eGRF,resulting from different equations, presented good correlation. However, Bland-Altman analysis indicated that there was significant bias in the four groups and the changes of eGFR, determined by two equations, was not consistent, when serum level of creatinine changed significantly. Conclusion In different populations,the eGFR,acquired by using CG equation and MDRD equation 5 might be not consistent,but could be correlative.