CKD-EPI方程估算肾小球滤过率的评价

摘要

Objective To compare the applicability of CKD-EPI equation with MDRD equation in predicting glomerular filtration rate(GFR)in patients with chronic kidney disease(CKD) and healthy controls, and the relative risk factor of the decrease of GFR was analyzed by CKD-EPI equation. Methods GFR of 91 cases of hospitalized patients with CKD and 198 cases of healthy controls were estimated by CKD-FPI and MDRD equation respectively[denoted as GFR( CKD-EPI) and GFR( MDRD) ]. Correlation and consistency between GFR (CKD-FPI) and GFR ( MDRD) were analyzed by Person correlation analysis and Bland-Altman analytic process. CKD stage of subj ects was assessed according to GFR( MDRD) . Scr, GFR( MDRD) and GFR(CKDEPI) of each stage were compared. Correlation between GFR(CKD-FPI) and other items were also analyzed. Results There was no significant difference of age,Scr,GFR(MDRD)and GFR(CKDEPI) between male an female group(P＜O. 05). There was fine correlation between GFR ( MDRD) and GFR( CKD-FPI) [GFR( MDRD) = 0. 944×GFR( CKD-FPI) +0. 612 , r2 = 0. 960 ( P＜O. 001) ]. BlandAltman analytic process indicated that there was fine consistency between GFR( MDRD) and GFR(CKD-EPI). All subjects were classified into 5 CKD stages according to GFR(MDRD). Compared with GFR( MDRD) ,.mean of GFR(CKD-EPI) in CKD Ⅰ、 Ⅱ、Ⅲ stage increased 0. 15,7. 34 and l. 60 mL. min-1 . (1. 73 m2 )-1 respectively, mean of GFR(CKD-FPI) in CKD Ⅳ、Ⅴ stage decreased 0. 25 and 0. 41 mL. min-1 ( 1. 73 m2) -1 respectively. GFR ( CKD-EPI) was negatively correlative to age , systolic blood pressure ( SBP) , diastolic blood pressure( DBP) ,serum creatinine( Scr) , serum uric acid( SUA) , fasting blood glucose( FBG) , urine protein( UP) and urine protein-to-creatinine ratio( UP/Ucr) , was positively correlative to total cholesterol( TC) and urine uric acid ( P＜O. 05) , but was not correlative to gender and triglyceride(P＞O. 05). Conclusion The application of CKD-FPI equation to estimate GFR could reduce systematical underestimation in healthy individuals by MDRD equation and extend the applicability of GFR. The decrease of GFR might be correlative to traditional risk factors.%目的 比较CKD-EPI方程与MDRD方程估算慢性肾脏疾病(CKD)患者和健康体检者肾小球滤过率(GFR)的适用性,并应用CKD-EPI方程分析GFR下降的相关危险因素.方法 选择湖南省常德市第一人民医院2010年6月至2010年11月住院CKD患者和健康体检者共289例,应用CKD-EPI方程和MDRD方程估算GFR[分别用GFR(CKD-EPI)和GFR(MDRD)表示],应用Person相关分析法和Bland-Altman分析法比较两种方程GFR估算值(eGFR)的相关性和一致性.根据GFR(MDRD)将受试者进行CKD分期,对各期血肌酐(Scr)、GFR(MDRD)、GFR(CKD-EPI)进行比较.GFR(CKD-EPI)与受试者其他指标进行相关性分析.结果 男、女组间年龄、Scr、GFR(MDRD)和GFR(CKD-EPI)差异无统计学意义(P＞0.05).两种方程eGFR具有良好的相关性,回归方程为GFR(MDRD)＝0.944×GFR(CKD-EPI)+0.612(r2＝0.960,P＜0.001).Bland-Altman分析结果显示,GFR(CKD-EPI)与GFR(MDRD)比较,两者具有较好的一致性.根据GFR(MDRD)将受试者分为5期.CKD Ⅰ、Ⅱ、Ⅲ期GFR(CKD-EPI)均值比GFR(MDRD)分别增高了4.15、7.34、1.60 mL·min-1·(1.73 m2)-1,而CKD Ⅳ、Ⅴ期比GFR(MDRD)分别降低0.25、0.41 mL·min-1·(1.73 m2)-1.GFR(CKD-EPI)与受试者年龄、收缩压(SBP)、舒张压(DBP)、Scr、血尿酸(SUA)、空腹血糖(FBG)、尿蛋白(UP)、尿蛋白与肌酐比值(UP/Ucr)呈负相关,与总胆固醇(TC)、尿尿酸(UUA)呈直线正相关(P＜0.05),与性别、三酰甘油(TG)无相关关系(P＞0.05).结论 应用CKD-EPI方程估算肾小球滤过率,能减低MDRD方程在健康人群中的系统性低估,扩宽估算肾小球滤过率的适用性.肾小球滤过率的下降与传统性危险因素相关.