中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2010年
4期
258-263
,共6页
陈海冰%张磊%包玉倩%李青%张锋%李鸣%于浩泳%周健%卢逢娣%项坤三%贾伟平
陳海冰%張磊%包玉倩%李青%張鋒%李鳴%于浩泳%週健%盧逢娣%項坤三%賈偉平
진해빙%장뢰%포옥천%리청%장봉%리명%우호영%주건%로봉제%항곤삼%가위평
糖尿病肾病%肾小球滤过率%血红蛋白A,糖基化
糖尿病腎病%腎小毬濾過率%血紅蛋白A,糖基化
당뇨병신병%신소구려과솔%혈홍단백A,당기화
Diabetic nephropathy%Glomerular filtration rate%Hemoglobin A.glycosylated
目的 评价糖尿病患者血糖水平对肾小球滤过率(GFR)公式估算结果的影响;比较不同血糖水平Cockcroft-Gauh(CG)公式和MDRD公式法估算GFR对诊断肾功能不全的差异.方法 选取1210例糖尿病患者,同步检测(99m)~Tc-GFR(iGFR)、Scr和糖化血红蛋白(HbAlc).运用CG和MDRD公式计算GFR估计值(eGFRcc、eGFRMDRI).依据肾脏病透析预后质量指南(K/DOQI)的建议将糖尿病患者分为iGFR正常组589例[NGFR组,iGFR≥90 ml·min~(-1)·(1.73 m~2)~(-1)],iGFR轻度下降组[GGFR组,60≤iGFR<90 ml·min~(-1)·(1.73 m~2)~(-1)]470例,iGFR中度下降组[MGFR组,30≤iGFR<60 ml·min~(-1)·(1.73 m~2)~(-1)]151例.根据HbAlc的四分位点(7.1%,10.5%)分为4组(<7.1%、7.1%～8.6%、8.7%～10.4%、≥10.5%),其中HbAlc<7.1%者定义为血糖控制较好组,HbAlc≥10.5%定义为血糖控制差组.采用Spearman相关分析、t检验、Bland-Altman分析、受试者工作特征(ROC)曲线等评估方程的偏离度、准确度,以及血糖对估算结果的影响.结果 eGFR_(MDRD)在各GFR亚组中均高估GFR;eGFR_(CG)在NGFR组中低估GFR,差异有统计学意义.Bland-Altman分析结果显示,血糖控制较差组的eGFR_(MDRD)的偏差高于血糖控制较好组的eGFR_(MDRD);血糖控制较差组的eGFR_(MDRD)15%和30%准确性低于血糖控制较好组的eGFR_(MDRD),差异有统计学意义.血糖控制较差组和较好组间eGFR_(CG)偏差及准确性差异均无统计学意义;而eGFR_(CG)的偏差高于eGFR_(MDRD),差异有统计学意义.血糖控制良好组CG公式和MDRD公式在诊断肾功能不全患者的ROC曲线下面积差异无统计学意义.血糖控制较差组eGFR_(MDRD) ROC曲线下面积显著大于eGFR_(CG)曲线下面积,差异有统计学意义.结论 糖尿病患者采用MDRD和CG公式法可导致GFR估计差误.MDRD公式的eGFR估计值受到血糖的影响较大,MDRD公式法高估GFR.MDRD公式在血糖控制较差的患者对肾功能不全患者的估算效应要优于CG公式.
目的 評價糖尿病患者血糖水平對腎小毬濾過率(GFR)公式估算結果的影響;比較不同血糖水平Cockcroft-Gauh(CG)公式和MDRD公式法估算GFR對診斷腎功能不全的差異.方法 選取1210例糖尿病患者,同步檢測(99m)~Tc-GFR(iGFR)、Scr和糖化血紅蛋白(HbAlc).運用CG和MDRD公式計算GFR估計值(eGFRcc、eGFRMDRI).依據腎髒病透析預後質量指南(K/DOQI)的建議將糖尿病患者分為iGFR正常組589例[NGFR組,iGFR≥90 ml·min~(-1)·(1.73 m~2)~(-1)],iGFR輕度下降組[GGFR組,60≤iGFR<90 ml·min~(-1)·(1.73 m~2)~(-1)]470例,iGFR中度下降組[MGFR組,30≤iGFR<60 ml·min~(-1)·(1.73 m~2)~(-1)]151例.根據HbAlc的四分位點(7.1%,10.5%)分為4組(<7.1%、7.1%～8.6%、8.7%～10.4%、≥10.5%),其中HbAlc<7.1%者定義為血糖控製較好組,HbAlc≥10.5%定義為血糖控製差組.採用Spearman相關分析、t檢驗、Bland-Altman分析、受試者工作特徵(ROC)麯線等評估方程的偏離度、準確度,以及血糖對估算結果的影響.結果 eGFR_(MDRD)在各GFR亞組中均高估GFR;eGFR_(CG)在NGFR組中低估GFR,差異有統計學意義.Bland-Altman分析結果顯示,血糖控製較差組的eGFR_(MDRD)的偏差高于血糖控製較好組的eGFR_(MDRD);血糖控製較差組的eGFR_(MDRD)15%和30%準確性低于血糖控製較好組的eGFR_(MDRD),差異有統計學意義.血糖控製較差組和較好組間eGFR_(CG)偏差及準確性差異均無統計學意義;而eGFR_(CG)的偏差高于eGFR_(MDRD),差異有統計學意義.血糖控製良好組CG公式和MDRD公式在診斷腎功能不全患者的ROC麯線下麵積差異無統計學意義.血糖控製較差組eGFR_(MDRD) ROC麯線下麵積顯著大于eGFR_(CG)麯線下麵積,差異有統計學意義.結論 糖尿病患者採用MDRD和CG公式法可導緻GFR估計差誤.MDRD公式的eGFR估計值受到血糖的影響較大,MDRD公式法高估GFR.MDRD公式在血糖控製較差的患者對腎功能不全患者的估算效應要優于CG公式.
목적 평개당뇨병환자혈당수평대신소구려과솔(GFR)공식고산결과적영향;비교불동혈당수평Cockcroft-Gauh(CG)공식화MDRD공식법고산GFR대진단신공능불전적차이.방법 선취1210례당뇨병환자,동보검측(99m)~Tc-GFR(iGFR)、Scr화당화혈홍단백(HbAlc).운용CG화MDRD공식계산GFR고계치(eGFRcc、eGFRMDRI).의거신장병투석예후질량지남(K/DOQI)적건의장당뇨병환자분위iGFR정상조589례[NGFR조,iGFR≥90 ml·min~(-1)·(1.73 m~2)~(-1)],iGFR경도하강조[GGFR조,60≤iGFR<90 ml·min~(-1)·(1.73 m~2)~(-1)]470례,iGFR중도하강조[MGFR조,30≤iGFR<60 ml·min~(-1)·(1.73 m~2)~(-1)]151례.근거HbAlc적사분위점(7.1%,10.5%)분위4조(<7.1%、7.1%～8.6%、8.7%～10.4%、≥10.5%),기중HbAlc<7.1%자정의위혈당공제교호조,HbAlc≥10.5%정의위혈당공제차조.채용Spearman상관분석、t검험、Bland-Altman분석、수시자공작특정(ROC)곡선등평고방정적편리도、준학도,이급혈당대고산결과적영향.결과 eGFR_(MDRD)재각GFR아조중균고고GFR;eGFR_(CG)재NGFR조중저고GFR,차이유통계학의의.Bland-Altman분석결과현시,혈당공제교차조적eGFR_(MDRD)적편차고우혈당공제교호조적eGFR_(MDRD);혈당공제교차조적eGFR_(MDRD)15%화30%준학성저우혈당공제교호조적eGFR_(MDRD),차이유통계학의의.혈당공제교차조화교호조간eGFR_(CG)편차급준학성차이균무통계학의의;이eGFR_(CG)적편차고우eGFR_(MDRD),차이유통계학의의.혈당공제량호조CG공식화MDRD공식재진단신공능불전환자적ROC곡선하면적차이무통계학의의.혈당공제교차조eGFR_(MDRD) ROC곡선하면적현저대우eGFR_(CG)곡선하면적,차이유통계학의의.결론 당뇨병환자채용MDRD화CG공식법가도치GFR고계차오.MDRD공식적eGFR고계치수도혈당적영향교대,MDRD공식법고고GFR.MDRD공식재혈당공제교차적환자대신공능불전환자적고산효응요우우CG공식.
Objective To investigate the influence of blood glucose level on the estimated glomeruhr filtration rate(eGFR)by Cockcroft-Gault(CG)and Modification of Diet in Renal Disease(MDRD)formula in diabetic patients,and to explore the difference between CG and MDRD formula to estimate GFR in different levels of blood glucose in the diagnosis of moderate renal insufficiency.Methods A total of 1210 diabetic patients(650 males and 560 females)were enrolled in this study.HbAlc,Scr and isotopic GFR(iGFR)((99m)~ Tc-DTPA)were measured.CG and MDRD formula were used to estimate the GFR(eGFR_(CG),eGFR_(MDRD)).The patients were divided into normal GFR group[NGFR,n=589,iGFR≥90 ml·min~(-1)·(1.73 m~2)~(-1)],gently decreased
GFR group[GGFR,n=470,60≤iGFR<90 ml·min~(-1)·(1.73 m~2)~(-1)],moderate and sever decreased GFR group[MGFR,n=151,30≤iGFR<60 ml·min~(-1)·(1.73 m~2)~(-1)]based on the K/DOQI suggestion. According to the quartile HbAlc level(7.1%,10.5%),patients were divided into four groups.Patients with HbAlc<7.1% were defined as well-controlled group,with HbAlc≥10.5% as poorly-controlled group.Spearman correlation,t test,Bland-Altman analysis and ROC curve were applied to investigate the bias and accuracy of formula,and the influence of blood glucose on eGFR.Results HbAlc was correlated with iGFR(r=0.17,P<0.01),eGFR_(CG)(r=0.22,P<0.01),eGFR_(MDRD)(r=0.29,P<0.01).The correlation between eGFR_(MDRD) and HbAlc was the strongest.eGFR_(MDRD) seemed to overestimate GFR.However,eGFR_(CG) seemed to underestimate GFR in well-controlled group.Bland-Altman analysis indicated that the bias of eGFR_(MDRD) with iGFR in poorly-controlled group was higher than that in well-controlled group.Compared with poorly-controlled group,the 15% and 30% accuracies of eGFR_(MDRD) in well-controlled group were significantly higher.There was no significant difference between poorly-controlled group and well-controlled group in eGFR_(CG).The bias of eGFR_(CG) with iGFR was significantly higher than that of eGFR_(MDRD) with iGFR.The area under ROC curve was significantly greater in eGFR_(MDRD) than that in eGFR_(CG)(P<0.05)in poorly-controlled group.Conclusions eGFR by MDRD and CG formula in diabetic patients may lead to discrepancies with GFR value,eGFR_(MDRD) overestimates the GFR value.MDRD equation is more accurate and robust in poorly-controlled diabetic patients with mederate renal insufficiency.
