肾小球滤过率评估公式在糖尿病患者中的适用性分析

目的评价常用的肾小球滤过率评估公式在我国2型糖尿病患者中的临床适用性。方法选择住院的2型糖尿病患者163例，将^99mTc—DTPA肾动态显像测定肾小球滤过率作为参考值（Standard GFR，sGFR），用简化MDRD、Cockcroft—Gauh（CG）、CKD—EPI公式计算GFR评估值，将不同公式估测的GFR与GFR参考值（sGFR）进行比较。结果（1）简化MDRD与CKD—EPI公式均高估患者GFR水平，但CKD—EPI评估值偏离程度小于简化MDRD公式；（2）当sGFR≥60ml／min时，C—G公式评估值明显低于sGFR，当sGFR〈60ml／min时，C—G公式评估值明显高于sGFR，与简化MDRD与CKD—EPI公式相比，C—G公式偏离程度较小；（3）CKD—EPI公式评估值在慢性肾脏病Ⅰ、Ⅱ期的患者中与sGFR符合度高，而在慢性肾脏病Ⅲ～Ⅴ期的患者中，C—G公式与sGFR符合度较高。结论CKD—EPI与C—G公式评估糖尿病患者GFR优于简化MDRD公式，其中CKD—EPI公式适用于CKDⅠ～Ⅱ患者，而C—G公式适用于慢性肾脏病Ⅲ～Ⅴ期患者。

Evaluating these equations to estimate glomerular filtration rate in patients with diabetes

Objective To evaluate the applicability of these equations to predict glomerular filtration rate（GFR） from serum creatinine in Chinese diabetic patients. Methods A total of 163 hospitalized diabetic patients （age 〉 18） were investigated. ^99mTc-DTPA plasma clearance was calculated and standardized by body surface area（sGFR）. GFRs estimated with abbreviated MDRD equation, Cockcroft- Gault equation and CKD-EPI equation were compared with sGFR. Results （ 1 ） Both Abbreviated MDRD equation and CKD-EPI equation seemed to systematically overestimate GFR,but the bias of CKD-EPI e- quation was smaller than Cockeroft-Gault equation. （2） cGFR was significantly higher than sGFR when sGFR≥60 ml/min and lower than sGFR when sGFR 〈 60 ml/min. The bias of Cockcroft-Gauh equation was smaller than Abbreviated MDRD equation and CKD-EPI equation. （3） The accuraney of CKD-EPI equation was better than others when sGFR≥60 ml/min,while the accurancy of Cockcrofi-Gauh equation was better when sGFR 〈 60 ml/min. Conclusion The CKD-EPI equation and Cockcroft-Gauh equation can estimate GFR accurately. CKD-EPI equation applies to CKD Ⅰ - Ⅱ patients,while the C-G equation applicable to patients with CKD Ⅲ - Ⅴ.