2019 年第 2 期 第 14 卷

三种常用公式对糖尿病肾病合并高血压患者肾小球滤过率估算的准确性比较

Accuracy of glomerular filtration rate estimation in hypertensive patients with diabetic nephropathy by three common formulas

作者：田瑞周芸

英文作者：

单位：030012太原，山西医科大学附属人民医院肾内科（田瑞为山西医科大学2016级肾脏内科专业在读硕士研究生）

英文单位：

关键词：糖尿病肾病；高血压；慢性肾脏病流行病学协作组肌酐公式；肾脏病膳食改良简化公式；肾小球滤过率；诊断价值

英文关键词：

• 摘要：

• 【摘要】目的    比较慢性肾脏病流行病学协作组（CKD-EPI）开发方程（CKD-EPIcr和CKD-EPIcys）和肾脏病膳食改良（MDRD）简化公式对糖尿病肾病（DN）合并高血压患者肾小球滤过率（GFR）估算的准确性。方法    收集2015年1月至2017年12月在山西医科大学附属人民医院确诊为DN，已行肾动态显像检查的89例住院患者的临床资料。按是否合并高血压分为DN不合并高血压组（24例）和DN合并高血压组（65例），每组按年龄分为2个亚组(≥60岁和18~59岁)。分别以CKD-EPIcr、CKD-EPIcys、简化MDRD估算其GFR（eGFR）值，分析该人群中不同eGFR公式的诊断准确性。结果    以肾动态显像结果为参考标准，≥60岁亚组DN患者不论是否合并高血压，其CKD-EPIcr、CKD-EPIcys、简化MDRD各公式计算eGFR值准确性一致，与标准值差异无统计学意义（P>0.05）。18～59岁亚组DN患者DN不合并高血压组，CKD-EPIcys公式计算eGFR值较CKD-EPIcr、简化MDRD公式更为准确（P>0.05）；相反，DN合并高血压组，CKD-EPIcr、简化MDRD公式计算eGFR值较CKD-EPIcys公式更准确（P>0.05）。≥60岁亚组不论是否合并高血压，肾图及各公式计算eGFR结果组间差异无统计学意义（P=0.347、0.977）。18～59岁亚组不论是否合并高血压，肾图及各公式计算eGFR结果组间比较差异均有统计学意义（均P<0.005）。结论    60岁及以上人群中，是否合并高血压对各估算公式影响不大。60岁以下人群中，DN不合并高血压者，CKD-EPIcys公式估算eGFR值更为准确；DN合并高血压者，简化MDRD、CKD-EPIcr公式估算准确性更高。

• 【Abstract】Objective    To compare the accuracies of Chronic Kidney Disease Epidemiology Collaboration(CKD-EPI) and Modification of Diet in Renal Disease(MDRD) in the estimation of glomerular filtration rate(GFR) in patients with diabetic nephropathy(DN) and hypertension. Methods    Clinical data of 89 patients who were diagnosed of DN and had renal dynamic imaging examination in People′s Hospital Affiliated to Shanxi Medical University were collected from January 2015 to December 2017. They were divided into non-hypertension group(n＝24) and hypertension group(n＝65), and each group was divided into 2 subgroups by the age of 60 years. Estimated GFR(eGFR) was respectively calculated by CKD-EPIcr, CKD-EPIcys, MDRD and the diagnostic accuracy was analyzed. Results    Regarding renal dynamic imaging results as the reference standard, the accuracies of CKD-EPIcr, CKD-EPIcys and MDRD in calculating eGFR were similar between DN patients over 60 years old with and without hypertension(P>0.05). In 18-59 years old patients, CKD-EPIcys showed a higher accuracy than CKD-EPIcr and MDRD in non-hypertension group(P>0.05), while CKD-EPIcr and MDRD were more accurate in hypertension group(P>0.05). In patients over 60 years old, there was no significant difference among eGFR values calculated by renal dynamic imaging and the three formulas in patients with and without hypertension (P=0.347, 0.977). There were significant differences of the eGFR values in hypertension group and non-hypertension group of 18-59 years old(all P<0.005). Conclusions    Different eGFR formulas show similar accuracy in elderly DN regardless of hypertension. Among the 18-59 years old people, CKD-EPIcys is more accurate for DN without hypertension, while the estimates by CKD-EPIcr and MDRD are more accurate when patients having hypertension.