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...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。展开更多
Background: Kidney disease, even when mild, was once considered so major an impediment to successful pregnancy and so dangerous to the mother’s wellbeing. High-risk pregnancy mainly associated to renal impairment may...Background: Kidney disease, even when mild, was once considered so major an impediment to successful pregnancy and so dangerous to the mother’s wellbeing. High-risk pregnancy mainly associated to renal impairment may occur in 10-20% of gestations and it is very important that renal function is closely monitored to prevent or minimize maternal and fetal complications. This study was designed to investigate the performance of Cockcroft-Gault CGeq and the simplified MDRDeq equations in healthy pregnant women to assess renal function. Methods: We studied 167 normal ambulatory pregnant women and kidney function was contemporaneously estimated through the CGeq and the simplified MDRDeq and calculated through the creatinine clearance (Ccr). Serum and urinary creatinine were assayed using Jaffé reaction method in the same AutoAnalyser. Results: When we compared calculated and estimated clearences for measurement of kidney function we observed that CGeq overestimated renal function (CGeq = 168.41 ± 38.80 ml/ min/1.73 m2, Ccr = 146.27 ± 30.49 ml/min / 1.73 m2, p < 0.001), MDRDeq underestimated renal function (Ccr = 146.27 ± 30.49 ml/min / 1.73 m2, MDRDeq = 129.15 ± 29.28 ml/min / 1.73m2, p < 0.001). Conclusions: Our results demonstrated that CGeq overestimated, MDRDeq underestimated significantly kidney function during gestation in healthy women and cannot be recommended to assess renal function in obstetric practice. Ccr remains a useful clinical tool in pregnant women until the development of a specific equation that considers the several important maternal renal physiological alterations and provides the measure of GFR the most unbiased and precise as possible.展开更多
文摘目的采用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。
文摘Background: Kidney disease, even when mild, was once considered so major an impediment to successful pregnancy and so dangerous to the mother’s wellbeing. High-risk pregnancy mainly associated to renal impairment may occur in 10-20% of gestations and it is very important that renal function is closely monitored to prevent or minimize maternal and fetal complications. This study was designed to investigate the performance of Cockcroft-Gault CGeq and the simplified MDRDeq equations in healthy pregnant women to assess renal function. Methods: We studied 167 normal ambulatory pregnant women and kidney function was contemporaneously estimated through the CGeq and the simplified MDRDeq and calculated through the creatinine clearance (Ccr). Serum and urinary creatinine were assayed using Jaffé reaction method in the same AutoAnalyser. Results: When we compared calculated and estimated clearences for measurement of kidney function we observed that CGeq overestimated renal function (CGeq = 168.41 ± 38.80 ml/ min/1.73 m2, Ccr = 146.27 ± 30.49 ml/min / 1.73 m2, p < 0.001), MDRDeq underestimated renal function (Ccr = 146.27 ± 30.49 ml/min / 1.73 m2, MDRDeq = 129.15 ± 29.28 ml/min / 1.73m2, p < 0.001). Conclusions: Our results demonstrated that CGeq overestimated, MDRDeq underestimated significantly kidney function during gestation in healthy women and cannot be recommended to assess renal function in obstetric practice. Ccr remains a useful clinical tool in pregnant women until the development of a specific equation that considers the several important maternal renal physiological alterations and provides the measure of GFR the most unbiased and precise as possible.
