摘要
目的评价慢性肾脏病流行合作方程（the chronic kidney disease epidemiology collaboration equation，CKDEPI equation）估测中国老年慢性肾脏病（chronic kidney disease，CKD）患者肾小球滤过率（glomerular filtration rate，GFR）的适用性。方法选择2008年6月至2009年9月在上海同济大学附属同济医院肾内科就诊的年龄≥65岁的CKD患者194例.所有患者同步检验^99mTc—GFR（reference GFR，rGFR），血清肌酐（Scr），并用简化肾脏病膳食改良试验方程（the abbreviated modification of diet in renal disease study equation，the abbreviated MDRD equation）、CKDEPI方程计算估测的GFR（estimated GFR，eGFR），Bland—Altman曲线对两者进行总体适用性评价。以rGFR≥或〈60mL·min^-1（1．73m^2）^-1为界，将患者分为高rGFR及低rGFR组，进一步评估不同方程在亚组的表现，包括估测偏差、精确度、30％准确性比较。结果（1）总体比较：eGFRCKD-EPI和eGFRMDRD均与rGFR相关（r=0．70，0．67，P〈0．05）；CKD—EPI方程与简化MDRD方程比较，其估测GFR的偏差[2．3mL·min^-1·（1．73m^2）^-1vs-3．7mL·min^-1·（1．73m^2）^-1,P〈0．05]及精确度[66．0mL·min^-1·（1．73m^2）·vs67．3mL·min^-1·（1．73m^2）^-1均有改善，但30％准确性无改善（54．64％vs56．70％，P〉0．05）；（2）高rGFR组，CKD—EPI方程估测GFR的偏差[1．2mL·min^-1·（1．73m^2）^-1vs-5．3mL·min^-1·（1．73m^2）^-1,P〈0．05]及精确度[80mL·min^-1·（1．73m^2）^-1vs84．9mL·min^-1·（1．73m^2）^-1]较简化MDRD方程均有改善，但30％准确性无改善（74．60％vs73．01％，P〉0．05）。（3）低rGFR组：二方程估测GFR的偏差、精确度及准确性相当。结论相对简化MDRD方程而言，CKD—EPI方程在总体和高GFR老年CKD人群中的适用性均有不同程度改善。因此，CKD—EPI方程可作为评估老年CKD患者GFR的首选方程。
Objective To compare the performance of the newly developed chronic kidney disease epidemiology collaboration （CKD-EPI） equation and the abbreviated MDRD equation in elderly patients with Chronic kidney disease （CKD）. Methods 194 CKD patients with age ≥ 65 years were enrolled （100 women and 94 men） in the present study. We used the renal dynamic imaging method to measure the GFR and estimated the GFR with the new CKD-EPI equation and the abbreviated MDRD equation. ^99 mTc-GFR was used as a reference standard GFR （rGFR） for the comparison between the two equations. The overall performances of the two equations were assessed with the Bland-Altman method. Performance in bias, precision and accuracy of the two equations in subgroups were further investigated.[subgroups was defined by rGFR, the level of rGFR was categorized as rGFR ≥ 60 or 〈 60 min^-1 .（1.73 m^2）^-1]. Results Both estimated GFRs （eGFRs） with the CKDEPI equation and the abbreviated MDRD equation were correlated well with rGFR （r=0.70,0.67, P〈 0.05）. For the whole population, the CKD-EPI equation showed less bias [-2.3 mL. min^-1 · （1.73 m^2） ^-1 vs -3.7 mL · min^-1 .（1.73 m^2） ^-1, P〈0.05] and higher precision [66.0 mL, min^-1 .（1.73 m^2）-^1 vs 67.3 mL. min^-1 .（1.73 m^2） ^-1] as compared with the abbreviated MDRD equation. However, the two equations showed similar accuracy of ±30 %（54.64 % vs 56.70 %, P〉0.05）. Similar results were observed in the group with a rGFR≥ 60 mL - min^-11 .（1.73 m^2） 1. For group with a rGFR 〈60 mL. min^-1 .（1.73 m^2） 1, the CKD-EPI equation did not exhibit better performance than the abbreviated MDRD equation for estimating GFR. Conclusions The CKD-EPI equation outperformes the abbreviated MDRD equation not only in the overall performance but also in high GFR level group. For the present, the CKD-EPI equation appears to be the first GFR prediction equation for elderly patients.
出处
《老年医学与保健》
CAS
2011年第5期282-285,共4页
Geriatrics & Health Care
