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目的评价目前临床常用的肾小球滤过率(GFR)评估方程在慢性肾脏病(CKD)中的适用性。方法选择2005年1月至2007年12月中山大学附属第三医院327例CKD患者,用Cockcroft-Gault(CG)方程、MDRD1方程、简化MDRD方程、Jelliffe1973(JE73)方程、Mawer(MA)方程、Hull(HU)方程、Jellife1971(JE71)方程、血肌酐倒数公式、Gate(GA)方程、Bjornsson(BJ)方程,分别预测GFR值,与99mTcDTPA测的GFR(sGFR)进行比较。结果Bland-Altman分析显示CG方程、BJ方程和HU方程估计的GFR和sGFR的一致性较好,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,JE方程和CG方程估测的GFR与X轴的斜率较其他方程更接近0。MDRD1方程较其他方程有较小的偏差。在所有方程中,BJ方程、JE方程和CG方程GFR符合率较高。在CKD的不同分期中,BJ方程、CG方程和JE方程具有较小的偏差和更优的准确性。结论当血肌酐的测定方法为酶法时,如果直接应用目前临床常用的GFR评估方程预测GFR,可能会产生明显的偏差。
Objective To evaluate the applicability of the commonly used glomerular filtration rate (GFR) assessment equation in chronic kidney disease (CKD). Methods A total of 327 patients with CKD from the Third Affiliated Hospital of Sun Yat-sen University from January 2005 to December 2007 were selected and the MDRD equation, the Jelliffe1973 (JE73) equation and the Mawer (MA) equation were simplified using the Cockcroft-Gault (CG) The Hull (HU) equation, the Jellife1971 (JE71) equation, the reciprocal expression of serum creatinine, the Gate (GA) equation and the Bjornsson (BJ) equation were used to compare the GFR values with the GFR (sGFR) measured by 99mTcDTPA. Results The Bland-Altman analysis showed that the GFR, GFR and sGFR estimated by the CG equation, the BJ equation and the HU equation were in good agreement. However, the agreement between GFR and sGFR estimated by all equations exceeded the pre-defined professional values. The linear regression results show that the GFR and X-axis slopes estimated by the JE and CG equations are closer to zero than the other equations. The MDRD1 equation has smaller deviations than the other equations. Among all equations, the BJ equation, JE equation and GF equation GFR coincidence rate higher. In different stages of CKD, the BJ, CG and JE equations have smaller deviations and better accuracy. Conclusion When serum creatinine is determined enzymatically, there may be significant deviations if GFR is estimated directly by the GFR assessment equation currently used in clinic.