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目的评价肾小球滤过率(GFR)评估方程在慢性肾脏病(CKD)患者不同分期中的适用性。方法选择近一年来在我院肾科就诊的CKD患者,将MDRD7方程、简化MDRD方程、Cockcroft Gault方程估计的GFR值用体表面积(BSA)标准化(7GFR、aGFR、cGFR),与BSA标准化的双血浆法99mTc DTPA测的GFR(sGFR)在不同CKD分期进行比较。结果入选了298例患者,男165例,女133例,年龄(52.5±15.5)岁。引发CKD的病因包括肾小球疾病、梗阻性肾病、肾动脉狭窄、慢性肾小管间质疾病、原因不明或其他疾病。在CKD不同分期,7GFR、aGFR、cGFR与sGFR均有统计学意义(P<0.001)。当sGFR<30ml·min-1·(1.73m2)-1时,7GFR、aGFR和cGFR均显著高于sGFR(P<0.05),sGFR越低,偏差越明显;当sGFR>60ml·min-1·(1.73m2)-1时,7GFR、aGFR和cGFR均显著低于sGFR(P<0.05),sGFR越高,偏差越明显。结论在CKD1、2期,7GFR、aGFR和cGFR过低估计sGFR;在CKD4、5期,过高估计sGFR。上述方程直接应用于我国CKD患者时,可能产生明显的偏差,有必要对其进行适当修正。
Objective To evaluate the applicability of the glomerular filtration rate (GFR) assessment equation in different stages of patients with chronic kidney disease (CKD). Methods CKD patients treated in our hospital in the past year were selected. The MDRD7 equation, simplified MDRD equation and GFR estimated by Cockcroft Gault equation were normalized with BSA (7GFR, aGFR, cGFR) Plasma 99m Tc DTPA measured GFR (sGFR) was compared at different CKD stages. Results A total of 298 patients were selected, including 165 males and 133 females, with an average age of (52.5 ± 15.5) years. Causes of CKD include glomerular diseases, obstructive nephropathy, renal artery stenosis, chronic tubulointerstitial disease, unexplained or other diseases. In different stages of CKD, 7GFR, aGFR, cGFR and sGFR were statistically significant (P <0.001). When sGFR <30ml · min-1 · (1.73m2) -1, the levels of 7GFR, aGFR and cGFR were significantly higher than those of sGFR (P <0.05). The lower the sGFR, the more obvious the deviation. When the sGFR> 60ml · min-1 · (1.73m2) -1, 7GFR, aGFR and cGFR were significantly lower than those of sGFR (P <0.05). The higher the sGFR was, the more obvious the deviation was. Conclusions In CKD stage 1 and 2, sGFR is underestimated by 7GFR, aGFR and cGFR. Overexpression of sGFR at stage 4 and 6 of CKD. When the above equation is directly applied to CKD patients in our country, there may be obvious deviation and it is necessary to correct it properly.