摘要
目的 评估肾脏病膳食改良试验(MDRD)、MDRD中国公式(MDRD_(CHN))、慢性肾病流行病学协作组(CKD-EPI)_(Cr)、CKD-EPI_(CysC)、CKD-EPI_(Cr-CysC)5种估算肾小球滤过率(eGFR)公式在评价肾小球滤过功能和诊断慢性肾病(CKD)的临床应用价值,明确最适公式。方法 纳入2 610例宁波大学附属第一医院门诊和住院患者作为研究对象,检测血清肌酐(Cr)和半胱氨酸蛋白酶抑制剂C(CysC)水平,分别采用5种公式评估eGFR,比较不同公式计算值的差异性。选取412例住院患者,以内生肌酐清除率(cCr)作为参考方法,分析其与5种eGFR结果的相关性,绘制受试者工作特征(ROC)曲线比较5种eGFR计算值诊断CKD的效能。选取239例健康人群,建立本实验室eGFR参考区间。结果 5种eGFR计算结果均呈偏态分布,两两比较差异大多具有统计学意义。5种eGFR与cCr均呈显著正相关,其中CKD-EPI_(Cr-CysC)的相关系数最高(r=0.903)。5种eGFR诊断CKD的ROC曲线下面积依次为0.968、0.969、0.970、0.967和0.976,CKD-EPI_(Cr-CysC)的诊断效能最佳(敏感性97.3%、特异性89.8%)。5种公式的健康人群95%可信区间下限分别为76、87、82、99和93mL/min/1.73m2。结论 在评估肾小球滤过功能和诊断CKD方面,以参考区间下限为93 mL/min/1.73m2的CKD-EPI_(Cr-CysC)公式诊断效率最佳,值得在宁波地区推广应用。
Objective To evaluate the clinical application value of the 5 estimated glomerular filtration rate(eGFR)formulas,inclu-ding MDRD,MDRD Chinese formula[MDRD_(CHN)],CKD-EPI_(Cr),CKD-EPI_(CysC) and CKD-EPI_(Cr-CysC),in asssing glomerular filtration function and diagnosing chronic kidney disease(CKD),and determine the most suitable formula for the local region.Methods A to-tal of 2610 outpatients and inpatients from The First Affiliated Hospital of Ningbo University were enrolled as the study subjects.Serum creatinine(Cr)and CysC levels were measured,and eGFR was estimated using the 5 formulas.The differences of eGFR values calcu-lated by different formulas were compared.In 412 inpatients,the correlations between endogenous creatinine clearance rate(cCr)and the 5 eGFR results were analyzed,and ROC curves were plotted to compare the diagnostic efficacy of the five eGFR values for CKD.The reference interval for eGFR was established using data from 239 healthy individuals.Results All the eGFR values calculated by the 5 formulas showed skewed distributions and differences of most pairwise comparisons were statistically significant.All the 5 eGFR values were significantly positively correlated with cCr.The CKD-EPI_(Cr-CysC) showed the highest correlation coefficient(r=0.903).The areas under the ROC curves for diagnosing CKD using the 5 eGFR formulas were 0.968,0.969,0.970,0.967 and 0.976,respectively.CKD-EPI_(Cr-CysC) showed the best diagnostic performance(sensitivity of 97.3%,specificity of 89.8%).The lower limits of the 95%confi-dence interval for healthy individuals were 76,87,82,99,and 93 mL/min/1.73m^(2) for the different formulas respectively.Conclusion Among the five eGFR formulas,CKD-EPI_(Cr-CysC) with a reference interval lower limit of 93 mL/min/1.73m^(2)was demonstrates as the best diagnostic efficiency for assessing glomerular filtration function and diagnosing CKD,and is worth promoting and applying in Ning-bo region.
作者
米民东
巩继勇
孙维杰
梁伟
MI Mindong;GONG Jiyong;SUN Weijie;LIANG Wei(Department of Clinical Laboratory,The First Affiliated Hospital of Ningbo University,Ningbo 315010,Zhejiang,China)
出处
《临床检验杂志》
CAS
2024年第6期456-460,共5页
Chinese Journal of Clinical Laboratory Science
基金
2022年度宁波市重点研发计划暨“揭榜挂帅”第三批项目(2022Z2202022)
宁波市科技局重点项目(2023J020,2023一2026)
中国人口福利基金会医学创新课题(SLB-6-20230912-351)
宁波市医学科技计划(2022Y05)
宁波大学附属第一医院院级课题(XGY2308)。
关键词
估算肾小球滤过率
慢性肾病
内生肌酐清除率
肾脏病膳食改良试验
MDRD中国公式
慢性肾病流行病学协作组
estimated glomerular filtration rate
chronic kidney disease
endogenous creatinine clearance rate
Modification of Diet in Renal Disease(MDRD)
MDRD Chinese formula
Chronic Kidney Disease Epidemiology Collaboration(CKD-EPI)
