吕潇阳, 钟良宝, 王善志, 朱永俊, 李晓燕. 肾小球滤过率评估方程在中国糖尿病合并慢性肾脏病患者中的适用性评价[J]. 临床肾脏病杂志, 2019, 19(10): 719-726,733. DOI: 10.3969/j.issn.1671-2390.2019.10.002
    引用本文: 吕潇阳, 钟良宝, 王善志, 朱永俊, 李晓燕. 肾小球滤过率评估方程在中国糖尿病合并慢性肾脏病患者中的适用性评价[J]. 临床肾脏病杂志, 2019, 19(10): 719-726,733. DOI: 10.3969/j.issn.1671-2390.2019.10.002
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    LV Xiao-yang, ZHONG Liang-bao, WANG Shan-zhi, ZHU Yong-jun, LI xiao-yan. Applicability evaluation of the GFR equations in Chinese patients with diabetes mellitus complicated with CKD[J]. Journal of Clinical Nephrology, 2019, 19(10): 719-726,733. DOI: 10.3969/j.issn.1671-2390.2019.10.002
    Citation: LV Xiao-yang, ZHONG Liang-bao, WANG Shan-zhi, ZHU Yong-jun, LI xiao-yan. Applicability evaluation of the GFR equations in Chinese patients with diabetes mellitus complicated with CKD[J]. Journal of Clinical Nephrology, 2019, 19(10): 719-726,733. DOI: 10.3969/j.issn.1671-2390.2019.10.002
    shu

    肾小球滤过率评估方程在中国糖尿病合并慢性肾脏病患者中的适用性评价

    Applicability evaluation of the GFR equations in Chinese patients with diabetes mellitus complicated with CKD

      摘要
    • 摘要: 目的 探讨临床上使用广泛的慢性肾脏病流行病学协助组（CKD-EPI）肾小球滤过率（GFR）评估方程、改良肾脏病膳食改良试验（MDRD）方程与近年来针对中国人开发的Feng方程、针对中国糖尿病患者改良的CKD-EPI糖尿病方程在中国糖尿病合并慢性肾脏病（CKD）患者中的适用性，进而为临床中准确估测糖尿病合并CKD患者GFR提供更精确的依据。方法 选取2型糖尿病合并CKD患者160名。收集患者性别、年龄、身高、体质量、血肌酐（Scr）及胱抑素C（Cys C）。以99mTc-DTPA肾动态显像法测定的GFR作为参考GFR（rGFR）。使用中国改良MDRD方程、CKD-EPIScr方程、CKD-EPICys C方程、CKD-EPIScr-Cys C方程、CKD-EPI糖尿病方程、FengCys C方程及FengScr-Cys C方程对估算GFR（eGFR）进行计算。采用Pearson相关性分析及κ检验比较各方程eGFR与rGFR之间的相关性及分期一致性，并使用Bland-Altman分析法比较各方程eGFR与rGFR的一致性限度。各方程eGFR之间的比较使用偏倚、精确度、10%准确率、30%准确率、50%准确率。定义GFR<60 mL·min-1·（1.73 m2）-1为肾功能不全的诊断标准，通过ROC曲线比较各方程诊断肾功能不全的效能。根据rGFR将患者分为A组（CKD 4~5期）、B组（CKD 3期）、C组（CKD 1~2期），比较不同分组中各方程的适用性。结果 在各方程eGFR之间的比较中，CKD-EPI糖尿病方程偏倚最小，与FengCys C方程、FengScr-Cys C方程比较差异有统计学意义（P<0.05）；精确度最高，与改良MDRD方程、CKD-EPICys C方程比较差异有统计学意义（P<0.05）。在7种方程的准确率比较中，CKD-EPI糖尿病方程10%、30%准确率均最高，与简化MDRD方程、CKD-EPIScr方程、CKD-EPICys C方程比较差异均有统计学意义（P<0.05）。Bland-Altman分析显示CKD-EPI糖尿病方程一致性限度最佳。在A组患者中，CKD-EPICys C方程eGFR与rGFR均值比较差异无统计学意义，偏倚最小，50%、30%准确率最高。B组患者与总体患者类似，CKD-EPI糖尿病方程偏倚最小，精确度最高，10%、30%、50%准确率均最高。结论 在7种方程的比较中，CKD-EPI糖尿病方程eGFR与rGFR拟合度最佳。在不同分组的比较中，CKD 4~5期患者CKD-EPICys C方程eGFR与rGFR拟合度最佳，CKD 3期患者CKD-EPI糖尿病方程eGFR与rGFR拟合度最佳，可分别用于估测糖尿病合并CKD不同分组患者的GFR。

       

      Abstract: Objective To explore applicability of Chronic Kidney Disease Epidemiology Collaboration(CKD-EPI)'s glomerular filtration rate (GFR) equations, including modified modification of diet in renal diseases (MDRD) equation, the Feng equation developed for Chinese in recent years, and modified CKD-EPI diabetes equation for Chinese patients with diabetes, in Chinese patients with diabetes mellitus complicated with CKD; furthermore, to provide a more accurate basis for accurate estimation of GFR in patients with diabetes complicated with CKD. Methods A total of 160 patients with type 2 diabetes with CKD were selected. The patient's data on gender, age, height, weight, blood creatinine (Scr) and cysteine protease inhibitor C (Cys C) were collected. GFR determined by 99mTc-DTPA renal dynamic imaging was used as a reference standard (rGFR). Modified equations for Chinese patients, including MDRD equation, CKD-EPIScr equation, CKD-EPICys C equation, CKD-EPIScr-Cys C equation, CKD-EPI diabetes equation, FengCys C equation and FengScr-Cys C equation, were used to estimate GFR (eGFR). Pearson correlation analysis and Kappa test were used to compare the correlation and staged consistency between eGFR and rGFR for each equation. Bland-Altman analysis was used to compare the consistency limits of eGFR and rGFR for each equation. Bias, precision, 10% accuracy, 30% accuracy and 50% accuracy were used to compare eGFR values for each equation. GFR<60 mL·min-1·(1.73 m2)-1 was defined as the diagnostic criteria for renal insufficiency, and the performances of various equations for diagnosing renal insufficiency were compared by ROC curve. Patients were divided into group A (CKD stage 4~5), group B (CKD stage 3), and group C (CKD stage 1~2) according to the rGFR, and the applicability of various equations in each group was compared. Results In the comparison of eGFR between the equations, the CKD-EPIdiabetes equation had the smallest bias, with differences of statistical significance compared to FengCys C equation and Feng Scr-Cys C equation (P<0.05); it had the highest precision, with differences of statistical significance compared to MDRD equation and CKD-EPICys C (P<0.05). In the comparison of accuracy between the 7 equations,, the 10% accuracy and the 30% accuracy of the CKD-EPIdiabetes equation were the highest, with differences of statistical significance compared to the simplified MDRD equation, CKD-EPIScr equation and CKD-EPICys C equation (P<0.05). Bland-Altman analysis showed that CKD-EPIdiabetes equation had the best consistency limit. In group A, the difference between CKD-EPICys C equation eGFR and rGFR was not statistically significant, with the least bias, and highest 10% accuracy, 30% accuracy and 50% accuracy. Group B were similar to the overall groups, CKD-EPIdiabetes equation had the least bias, the highest precision, 10% accuracy, 30% accuracy and 50% accuracy. Conclusions Among the 7 equations, the CKD-EPIdiabetes equation has the best fit between eGFR and rGFR. In the grouped comparison, the CKD-EPICys C equation has the best fit in patients with CKD stage 4~5, CKD-EPIdiabetes equation has the best fit in patients with CKD stage 3. The two equations can be used for estimation of GFR in different groups of patients with diabetes complicated with CKD.

       

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