摘要
目的探讨血清肌酐（sCr）实验室分析变异对估算肾小球滤过率（eGFR）及慢性肾脏病（CKD）分期的影响。方法收集就诊并检测sCr者,年龄20-89岁,sCr介于参考区间上限（URL）±12%×URL之间的人群共13157例,其中男9886例,女3271例。将s Cr检测结果分别递增或递减4%、8%、12%及原始结果,共分为7组,观察不同程度sCr实验室分析变异对eGFR及CKD分期的影响。结果 sCr在URL±12%URL范围内,随着年龄的增加,sCr呈上升趋势;而eGFR随着年龄的增加而逐渐降低（P〈0.05）。eGFR结果较原始结果的平均偏倚随着sCr检测结果的实验室变异增大而增大,sCr检测结果负向偏倚12%时,eGFR结果的正向偏倚达16.73%。当sCr结果正向偏倚达12%时,男性患者CKD分期G3期（eGFR在30-59ml/min/1.73m^2）所占比例可增加20%,而女性患者可增加近30%;当sCr负偏倚达12%时,女性G3期患者所占比例由38.56%减少至10.42%,而男性患者则减少近7%。结论 sCr实验室分析变异在允许范围内的改变,即可引起eGFR较大的偏倚,从而导致患者CKD分期的改变,eGFR的正确报告关键在于sCr的准确检测。
Objective To evaluate the effects of analytic variations in creatintine measurements on estimated glomerular filtration rate（ eGFR） and the classification of chronic kidney disease（CKD）. Methods A total of13 157 patients,including inpatients,outpatients and health individual,were enrolled,whose creatinine range from upper reference limit（URL）-12%×URL to URL＋12%×URL. There were 9886 males and 3 271 females with an age range of 20-89 years. The results of s Cr incremented or decremented 4%,8%,12% and original results were divided into 7 groups. The effects of different degree of analytic variation in s Cr measurement on e GFR and classification of CKD using eGFR were evaluated. Results When sCr was in the range of URL±12%×URL,creatintine increased with age,on the contrary,e GFR decreased with age（P〈0.05）. The mean bias of the results of e GFR compared with the original results of e GFR was increased with the analytic variation of s Cr.When the results of s Cr had a reverse analytic bias of 12%,the results of e GFR had a forward bias of 16. 73%.When s Cr results had a forward analytic bias of 12%,the male patients in stage G3（ eGFR in 30-59 ml/ min/1.73m^2）,according to the classification of CKD using e GFR,increased about 20%; while women in this stage could increase by nearly 30%. When s Cr results had a reverse analytic bias of 12%,the percentage of female patients in stage G3 could decrease from 38. 65% to 10. 42%; while male patients could decrease by 7%. Conclusion The analytic variation of creatinine change in laboratory testing tolerance range can cause large shift in the distribution of eGFR,which can cause change in the classification of patients. The correct e GFR report relies on the accurate detection of sCr. Routine reporting of eGFR alongside creatintine should pay attention to the detection accuracy of sCr.
出处
《安徽医科大学学报》
CAS
北大核心
2016年第7期993-997,共5页
Acta Universitatis Medicinalis Anhui
基金
国家高技术研究发展计划(863计划)(编号:2011AA02A111)
