CAJ | 학술논문

目的：比较99m Tc-DTPA肾动态显像（ Gates′法）、简化MDRD方程及CKD-EPI方程评价慢性肾脏病（ CKD）患者肾小球滤过率（ GFR）的价值。方法选择CKD成人患者159例，以双血浆法测定的GFR（ rGFR）作为参照，应用Pearson相关分析及Bland-Altman分析比较Gates′法、简化MDRD方程及CKD-EPI方程估算的GFR（eGFR）的相关性、一致性及准确性。结果 Gates′法估测的eGFR与rGFR呈正相关（r＝0.900，P＜0.001），高于简化MDRD方程（r＝0.816，P＜0.001）及CKD-EPI方程（r＝0.825，P＜0.001）。3种方法都低估了rGFR值，但是Gates′法的偏差最小[-3.4 mL/（min·1.73 m2）]、精确度最高[11.8 mL/（min·1.73 m2）]、±30％的准确性最高（71.7％）。除了CKD1～2期，Gates′法±30％的准确性均高于简化MDRD方程及CKD-EPI方程（ P＜0.05）。简化MDRD方程与CKD-EPI方程准确性比较差异无统计学意义（P＞0.05）。结论3种方法均低估了rGFR。 CKD-EPI方程并不优于简化MDRD方程。 Gates′法的准确性高于其他两种方程。
목적：비교99m Tc-DTPA신동태현상（ Gates′법）、간화MDRD방정급CKD-EPI방정평개만성신장병（ CKD）환자신소구려과솔（ GFR）적개치。방법선택CKD성인환자159례，이쌍혈장법측정적GFR（ rGFR）작위삼조，응용Pearson상관분석급Bland-Altman분석비교Gates′법、간화MDRD방정급CKD-EPI방정고산적GFR（eGFR）적상관성、일치성급준학성。결과 Gates′법고측적eGFR여rGFR정정상관（r＝0.900，P＜0.001），고우간화MDRD방정（r＝0.816，P＜0.001）급CKD-EPI방정（r＝0.825，P＜0.001）。3충방법도저고료rGFR치，단시Gates′법적편차최소[-3.4 mL/（min·1.73 m2）]、정학도최고[11.8 mL/（min·1.73 m2）]、±30％적준학성최고（71.7％）。제료CKD1～2기，Gates′법±30％적준학성균고우간화MDRD방정급CKD-EPI방정（ P＜0.05）。간화MDRD방정여CKD-EPI방정준학성비교차이무통계학의의（P＞0.05）。결론3충방법균저고료rGFR。 CKD-EPI방정병불우우간화MDRD방정。 Gates′법적준학성고우기타량충방정。
Objective To compare the applications of renal dynamic imaging with 99m Tc-DTPA ( Gates′met-hod), abbreviated MDRD (aMDRD) equation and CKD-EPI equation in renal function assessment in the patients with chronic kidney disease ( CKD) .Methods A total of 159 adult patients with CKD were included .The glomerular filtra-tion rate (GFR) obtained by Gates′method, aMDRD equation and CKD-EPI equation against 99mTc-DTPA dual plasma clearance ( rGFR) with Pearson correlational analyses and Bland -Altman method were performed .Results A statistical-ly significant correlation was found between rGFR and Gates′method (r=0.900, P<0.001), which was higher than aM-DRD formula (r=0.816, P<0.001) and CKD-EPI formula (r=0.825, P<0.001).Bland-Altman analysis showed that all equations underestimated the rGFR in the overall performance , but Gates′method had less bias [ -3.4 mL/( min· 1.73 m2 ) ] , good precision [ 11.8 mL/( min · 1.73 m2 ) ] , and greatest accuracy within ±30% of rGFR (71.7%) than aMDRD and CKD-EPI equations.In each stage of CKD, excepting patients in Stage 1 Stage 2, a statisti-cally significant higher accuracy within ±30%was found of the Gates′method compared to the accuracy of the aMDRD formula or CKD-EPI formula (P<0.05).No difference between the accuracies of the aMDRD formula and the CKD -EPI formula was found (P>0.05).Conclusion All three methods underestimate the rGFR, the new CDK-EPI equa-tion performs no better than aMDRD equation .Both equations can′t provide as much accuracy as Gates′method.