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目的比较经体表面积校正后Cockcroft-Gault(CG)、美国肾脏病膳食改良实验(modification of diet inrenal disease,MDRD)、美国简化MDRD、中国MDRD、中国简化MDRD方程在良性小动脉肾硬化症患者中预测肾小球滤过率(glomerular filtration rate,GFR)的适用性。方法选取2010年2月至2011年11月在广东省人民医院确诊为良性小动脉肾硬化症的患者140例为研究对象,以双血浆法99mTc-DTPA血浆清除率为GFR参考值,将各方程的估算GFR与双血浆法所测的结果进行对比分析。结果双血浆法所测的GFR值为(39.3±22.3)mL.min-1.1.73 m-2。校正后CG、MDRD、美国简化MDRD方程均低估(-6.90、-3.48、-2.59 mL.min-1.1.73m-2)实际GFR,而中国MDRD、中国简化MDRD方程均高估(4.07、5.96 mL.min-1.1.73 m-2)实际GFR;MDRD方程偏离度(363.16任意单位)明显小于其他方程(876.24、1 267.12、483.82、1 516.90任意单位),并且精密度、30%准确性明显优于中国MDRD、中国简化MDRD方程,差异有统计学意义(P<0.05)。结论以上各估算GFR方程对良性小动脉肾硬化症患者适用性均欠佳,鉴于MDRD方程偏离度、精密度、准确性的优越性,选用MDRD方程可能更加合适。
Objective To compare the effects of Cockcroft-Gault (CG), modified of diet in renal disease (MDRD), simplified MDRD in the United States, MDRD in China and Simplified Chinese MDRD equation in patients with benign arteriolar nephrosclerosis Predict the applicability of glomerular filtration rate (GFR). Methods A total of 140 patients with benign arteriolar nephrosclerosis diagnosed in Guangdong Provincial People’s Hospital from February 2010 to November 2011 were enrolled in this study. The plasma clearance rate of 99mTc-DTPA by double plasma was used as reference value of GFR. The estimated GFR and double plasma test results were compared. Results The GFR measured by the double plasma method was (39.3 ± 22.3) mL.min-1.1.73 m-2. The corrected GF, MDRD and the simplified MDRD equations in the United States all underestimated the actual GFR (-6.90, -3.48, -2.59 mL.min-1.1.73m-2), while the Chinese MDRD and simplified Chinese MDRD equations were both overestimated (4.07 and 5.96 mL .min-1.1.73 m-2) The actual GFR; MDRD equation deviation (363.16 arbitrary units) was significantly smaller than other equations (876.24,1 267.12,483.82,1 516.90 arbitrary units), and the precision, 30% accuracy was excellent In China MDRD, China simplified MDRD equation, the difference was statistically significant (P <0.05). Conclusion The above GFR equations are not suitable for patients with benign arteriolar nephrosclerosis. In view of the superiority of MDRD equation in terms of deviation, precision and accuracy, MDRD equation may be more suitable.