不同肾小球滤过率评估公式在2型糖尿病患者中的适用性

doi:10.3969/j.issn.2095-9400.2020.09.009

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摘要目的：比较不同肾小球滤过率（GFR）评估公式对2型糖尿病（T2DM）患者肾功能的诊断价值。方法：回顾性分析322例T2DM患者的资料，以24小时肌酐清除率计算得到的GFR为标准肾小球滤过率（rGFR），以C-G公式、简化MDRD公式、改良的MDRD中国公式和CKD-EPI公式计算得到的GFR为估算的肾小球滤过率（eGFR），比较各eGFR的准确度、精确度和偏差、ROCAUC，并根据不同年龄、糖化血红蛋白分层分析。结果：CKD-EPI公式估算的GFR与rGFR的相关系数最高（r=0.788）。CKD-EPI公式的15%准确度（P15）、30%准确度（P30）最高，分别为48.1%、73.6%。Bland-Altman图显示简化MDRD公式的偏差最小，CKD-EPI公式精确度最高。MDRDC公式、CKD-EPI公式诊断慢性肾功能不全的ROCAUC相等且最大。年龄≥60岁组和18～60岁组中均以CKD-EPI公式的P30、P50最高，精确度最好。CKD-EPI公式在不同糖化血红蛋白组精确度均最好，准确度均最高。结论：CKD-EPI公式更适合于估测我国T2DM患者的GFR，同时在不同年龄、糖化血红蛋白下均最适用。

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	朱思梦
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关键词 ： 2型糖尿病, 肾小球滤过率, 肾小球滤过率评估公式, CKD-EPI公式

Abstract：Objective: To evaluate the different glomerular filtration rate assessment formulas in type 2 diabetic patients. Methods: The data of 322 patients with type 2 diabetes mellitus were analyzed retrospectively, the glomerular filtration rate calculated by 24-hour creatine clearance rate was rGFR, eGFR was calculated by C-G formula, simplified MDRD formula, and the improved MDRD China formula and CKD-EPI formula, to compare the accuracy, accuracy, deviation, ROCAUC of each eGFR, and hierarchical analysis at different ages and glycosylated hemoglobin. Results: The correlation coefficient between GFR estimated by CKD-EPI formula and rGFR was the highest, r=0.788. The P15 and P30 of CKD-EPI formula were the highest, which are 48.1% and 73.6%, respectively. Bland-Altman diagram showed minimum deviation between simplified MDRD formula and rGFR, CKD-EPI formula had the highest accuracy. The area under ROC curve of MDRDC formula and CKD-EPI formula in the diagnosis of chronic renal insufficiency was equal and the largest. In the group of age≥60 years old and the group of 18<age<60 years old, the correlation of CKD-EPI formula was the best, P30 and P50 were the highest, and the highest accuracy. CKD-EPI formula had the best P30 and P50, the highest accuracy in different glycosylated hemoglobin. Conclusion: The CKD-EPI formula was most suitable for the estimation of GFR in Chinese patients with type 2 diabetes mellitus at the same time under different ages and glycosylated hemoglobin.

Key words： type 2 diabetes mellitus glomerular filtration rate glomerular filtration rate estimation equations CKD-EPI formula

收稿日期: 2019-05-20

通讯作者: 倪连松，主任医师，硕士生导师，Email：niliansong@qq.com。

作者简介: 朱思梦（1992-），女，浙江温州人，硕士生。

链接本文:

https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2020.09.009 或 https://xb.wmu.edu.cn/CN/Y2020/V50/I9/733

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