, , ， ， *

(1.Department of Nuclear Medicine， the Second Hospital of Anhui Medical University，Hefei 230601, China； 2.Department of Laboratory,Cancer Hospital,Chinese Academy of Sciences, Hefei 230031, China)

Application of estimation equations for glomerular filtration rate intype 2 diabetes mellitus

LIFei1,DENGQingmei2,HUANGShan1，ZHANGGang1，ZHANGJingmiao1*

(1.DepartmentofNuclearMedicine，theSecondHospitalofAnhuiMedicalUniversity，Hefei230601,China； 2.DepartmentofLaboratory,CancerHospital,ChineseAcademyofSciences,Hefei230031,China)

Objective To investigate the application value of chronic kidney disease epidemiology collaboration (CKD-EPI) equations and amendatory equations for calculating glomerular filtration rate (GFR) in Chinese patients with diabetes， including CKD-EPI serum creatinine (Scr) equation (CKD-EPIscr)， CKD-EPI serum cystatin C (ScysC) equation (CKD-EPIscysc)， combination of CKD-EPIscrand CKD-EPIScr-SCysC(CKD-EPIScr-SCysC)， Asian modified CKD-EPI equation (CKD-EPIAsian), Chinese diabetes CKD-EPI equation (CKD-EPIDiabetes), refitted modification of diet in renal disease (MDRD) equation (rMDRD), Cockcroft-Gault equation (CG) and Simplified MDRD equation. Methods Serum creatinine (Scr) was detected using basic picric acid method, serum cystatin C (CysC) was measured by Latex enhanced turbidimetric, and the reference value of GFR was worked out by99Tcm-DTPA renal dynamic imaging and standardization of body surface area. Relation of Scr, Scysc, GFR measured by every equations and rGFR were analyzed. The accuracy of 30% of each equation, the consistency and deviation of the evaluation of renal function by each equation were compared. The diagnostic efficacy in GFR<60 ml/(min · 1.73 m2) was compared using the receiver operating characteristic (ROC) curve. Results The rGFR had negative correlation with Scr、ScysC (bothP<0.001). The rGFR had positive correlation with GFR measured by CKD-EPIScr, CKD-EPIScysC, CKD-EPIScr-SCysC, CKD-EPIAsian, CKD-EPIDiabetes, rMDRD, CG and Simplified MDRD(allP<0.001). The coincidence rate between 30% of rGFR and GFR measured byCKD-EPIDiabetesand simplified MDRD were higher.There was no significant difference of rGFR and GFR measured by CKD-EPIScr, CKD-EPIScysC, CKD-EPIScr-SCysC, CKD-EPIAsian, CKD-EPIDiabetes, rMDRD, CG and Simplified MDRD. GFR measured by CKD-EPIDiabeteshas the best consistent degree with rGFR. ROC curve showed that the area under curve of GFR measured by CKD-EPIDiabeteswas largest and the Youden index was the highest. Conclusion There are different degrees of deviation in eGFR predicted by the eight kinds of equations. The accuracy and consistency of CKD-EPIDiabetesin Chinese 2-type diabetes is the best.

Diabetes mellitus, type 2； Glomerular filtration rate； Estimated glomerular filtration rate equations

目前糖尿病肾病已成为终末期肾病的第2位原因[1]。肾小球滤过率(glomerular filtration rate， GFR)是临床评估肾功能的直接有效指标，是慢性肾脏病分期依据。菊粉清除试验是评估GFR的金标准，但方法繁杂，仅用于科研，临床应用较少。目前多以99Tcm-二乙烯三胺五醋酸(99Tcm-DTPA)法作为GFR测量的标准方法[2-3]，但由于显像设备不够普及，其临床应用受限。为方便临床应用，因此产生了诸多GFR评估方程。Silveiro等[4]报道美国慢性肾脏病流行病学协作组(chronic kidney disease epidemiology collaboration， CKD-EPI)及肾脏病膳食改良实验(modification of diet in renal disease， MDRD)方程都难以适用于糖尿病患者。本研究以99Tcm-DTPA法为计算GFR的金标准，探讨MDRD[5-6]、Cockcroft-Gault(CG)[5]、CKD-EPI[7-8]等系列方程在我国2型糖尿病患者的适用性，为GFR评估方程在临床应用提供理论依据。

1 资料与方法

1.1一般资料 收集2016年1月—12月在我院核医学科进行肾功能显像测定GFR的2型糖尿病患者77例，其中男57例、女20例，年龄28～83岁，平均(61.1±12.3)岁。排除标准：①孕妇、肌肉萎缩、病理性肥胖、急性肾功能不全或急性肾功能损伤；②高度水肿，大量胸、腹腔积液或严重心功能不全；③重度肝脏疾病；④严重营养不良，肢体缺如；⑤酮症酸中毒；⑥1型糖尿病；⑦合并使用西咪替丁、甲氧苄啶等影响血清肌酐(serum creatinine， Scr)水平者；⑧甲状腺功能亢进或甲状腺功能减退。

1.2仪器与方法

1.2.1仪器与试剂 Beckman UniCel DxC800生化分析仪，试剂购自四川生物科技股份有限公司；显像仪器为GE InfiniaVCHawkeye 4双探头SPECT仪，配低能高分辨准直器；Xeleris肾功能处理软件由GE公司提供；显像剂99Tcm-DTPA购自无锡江源公司，放化纯>95%，放射性活度111～185 MBq。

1.2.2测定方法 血清半胱氨酸蛋白酶抑制剂C(serum cystatin C， ScysC)采用胶乳增强免疫透射比浊法测定，血清Scr采用碱性苦味酸法测定。9……