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目的评价现有在中国人群基础上开发的肾小球滤过率(GFR)评估方程对老年慢性肾脏病(CKD)患者的适用性。方法选择103例老年CKD患者,用中国方程、瑞金方程分别预测GFR值,与体表面积标准化99mTc DTPA测的GFR(sGFR)进行比较。结果Bland-Altman分析显示瑞金方程估计的GFR和sGFR的一致性最好,但所有方程估计的GFR和sGFR的一致性限度均超过事先规定的专业界值。线性回归结果显示,瑞金方程估测的GFR与X轴的斜率比其他方程更小。瑞金方程、MDRD1方程和中国5方程估测GFR15%符合率、30%符合率和50%符合率均较高,但所有方程估测GFR30%符合率依然低于70%。在CKD的不同分期中,瑞金方程和MDRD1方程估测GFR15%符合率、30%符合率和50%符合率均较高。结论当血肌酐的测定方法为酶法时,如果直接应用目前在中国人群基础上开发出的GFR评估方程预测老年CKD患者的GFR,可能会产生明显的偏差。
Objective To evaluate the applicability of the GFR evaluation equation developed on the basis of the Chinese population to elderly patients with chronic kidney disease (CKD). Methods A total of 103 elderly CKD patients were selected. The GFR values were predicted by the Chinese equation and the Ruijin equation, respectively, and compared with the GFR (sGFR) measured by 99mTc DTPA with a standardized body surface area. Results Bland-Altman analysis showed that the agreement between GFR and sGFR estimated by the Ruijin equation was the best, but the agreement between GFR and sGFR estimated by all equations exceeded the pre-defined professional values. The linear regression results show that the slope of GFR and X-axis estimated by the Ruijin equation is smaller than other equations. The coincidence rates of GFR15%, Ruijin equation, MDRD1 equation and Chinese 5 equation were high, and the coincidence rate of 30% coincidence rate and 50% coincidence rate was high. However, the coincidence rate of GFR30% of all the equations was still less than 70%. In different stages of CKD, the Ruijin equation and MDRD1 equation estimated GFR15% coincidence rate, 30% coincidence rate and 50% coincidence rate were higher. Conclusion When serum creatinine is determined enzymatically, there may be a significant bias if GFR assessment based on the current Chinese population is used to predict GFR in elderly patients with CKD.