摘要
目的开发适合我国慢性肾脏病(CKD)患者的肾小球滤过率(GFR)评估方程。方法收集国内不同地域、肾功能不同分期的CKD患者684例的有关资料。随机选取454例为开发组,230例为验证组。以双血浆法^(99m)Tc-DTPA血浆清除率为GFR参考值。(1)在简化MDRD方程中添加种族系数；(2)多元逐步回归线法开发新的GFR评估方程；(3)将上述两种改良的方程与改良前简化MDRD方程进行偏离度、精确度、准确性比较。结果684例患者中,男352例,女332例,平均年龄(49．9±15．8)岁。上述两种改良的简化MDRD方程在肾功能不同分期内偏离度分别为543．0、677．2和2175．0任意单位；精确度分别为57．5、56．5和60．7 ml·min^(-1)·(1．73 m^2)^(-1)；准确性均优于改良前简化MDRD方程,差异有统计学意义(30%的准确性由66．1%提高至77．8%和79．6%,P＜0．05)。结论基于我国CKD人群特点,改良的简化MDRD方程与改良前方程相比,表现了显著的优势,可以替代改良前简化MDRD方程,应用于我国CKD患者的GFR评估。
Objectives To modify glomerular filtration rate （GFR） estimating equation （also called abbreviated MDRD equation） based on plasma creatinine （Pcr） and other demographic data from Chinese chronic kidney disease （CKD） population, and compare the diagnostic performance of the modified abbreviated MDRD equations with that of original abbreviated MDRD equation in different CKD stages. Methods Six hundred and eighty-four patients with CKD including 352 males and 332 females,with average （49.9＋15.8） years,were collected from 9 renal institutes of university hospital located in 9 different geographic regions of China,and were enrolled in this study from June 2004 to September 2005. Four hundred and fifty-four cases were randomly selected to be included in the training samples, and the remaining 230 cases were used as testing samples. Using ^99mTc- diethylene triamine pentaacetic acid（^99mTc-DTPA） plasma clearance by dual plasma sampling method as reference GFR（rGFR）, the original abbreviated MDRD equation was modified by the following two methods. Firstly, a racial factor for Chinese was added to the original abbreviated MDRD equation. Secondly, multiple linear regression was applied to the training sample, and the coefficient associated with each variable in the original abbreviated MDRD equation was modified respectively. The modified equations were validated in the testing samples and were compared with the original abbreviated MDRD equation. Results Both modified abbreviated MDRD equations showed significant performance improvement in bias （the areas between the regression line of difference and a common distance along the zero difference line were 543.0, 677.2, and 2175.0 arbitrary units, respectively）, precision [the widths between the 95% limits of agreement for the regression line of difference were 57.5,56.5 and 60.7 ml.min^-1- （1.73 m^2）^-1, respectively]. Compared with the original abbreviated MDRD equation, the 30% accuracy of modified abbreviated MDRD equations was significantly higher （from 66.1% to 77.8% and 79.6%, P 〈 0.05）. Conclusions Compared with original abbreviated MDRD equation, the modified abbreviated MDRD equations based on the Chinese CKD patients offer significantly advantages in different CKD stages. It can be applied to GFR estimation in substitution of original abbreviated MDRD equation.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2006年第10期589-595,共7页
Chinese Journal of Nephrology
关键词
肾疾病
肾小球滤过率
评估方程
血浆清除率
Kidney disease
Glomerular filtration rate
Estimate equation
Plasma clearance
