摘要
目的通过分析肾脏病饮食改良（MDRD）研究方程及慢性肾脏疾病流行病学协会（CKD-EPI）方程CKD-EPIeGFRcr、CKD-EPI eGFRcya和CKD-EPI eGFRer-cya等4种估算肾小球滤过率（eGFR）评估方程在评价移植肾功能中的差异，探讨评估移植肾功能的最佳方法。方法回顾性分析2000年1月至2015年3月接受肾移植且资料完整的213例受者的临床资料，根据CKD-EPI在2009、2012年制定的基于血清肌酐和胱抑素C两种指标的方程及MDRD方程来计算出eGFR，通过Pearson相关性分析、Bland-Altman一致性分析、Cox多因素分析对比分析4种eGFR方程。结果MDRD、eGFRcr、eGFRcys和eGFRcr-cys评估移植肾功能不全的发生率分别为49．3％、43．7％、49．8％和52．1％；经MDRD评估eGFR≥60ml·min-1·1．73m-2的受者，再经eGFRcys和eGFRcr-cys评估后分别有19．5％和11％的受者eGFR〈60ml·min-1·1．73m-2。血清胱抑素C与血清肌酐、MDRD、eGFRcys、eGFRcr-cys具有明显的相关性，相关系数分别为0．67、0．61、0．65、0．77。根据eGFRcys、eGFRcr-cys方程所得数据评估的CKD分期与移植肾功能丧失的风险呈正相关。eGFRcys、eGFRcr-cys两种方程不可互相替代，仅eGFRcr-cys与其余3种方程显示出明显的相关性。结论相比较其他3种方程，基于血清胱抑素C与血清肌酐两种指标的eGFRcr-cys方程在估算肾移植受者的GFR及评估移植肾功能丧失风险时最精确。
Objective To compare the differences of the four estimating equations about MDRD, CKD-EPI eGFRcr, CKD-EPI eGFRcys, and eGFRcr-cys in evaluating the renal function of kidney transplant recipients, and explore the optimal equations to estimate the renal allograft function. Method Between January 2000 to March 2015, a total of 213 renal transplant recipients with data integrity were enrolled, eGFR was calculated using the equations： Modification of Diet in Renal Dis-ease [eGFR （MDRD）, the creatinine-based equation （CKD-EPI eGFRcr）, the CKD EPI cystatin C equation （CKD- EPI eGFRcys）, and CKD EPI creatinine ＋ cystatin C equation （CKD-EPI eGFcr-cys ） drafted by Chronic Kidney Disease Epidemiology Collaboration （CKD-EPI） in 2009 and 2012. We assessed the performance of these four eOFR equations by Pearson correlation analysis, Bland-Altman plot, and Cox regression analysis. Result The incidence of reduced kidney function was 49. 3% using MDRD, 43. 7% using eGFRcr, 49. 8% using eGFRcys, and 52. 1% using eGFRcr-cys, respectively. In recipients with eGFR ≥60 ml·min·1.73 m2 estimated by MDRD, 19. 5% and 11% had eGFR 〈60 ml.min. 1.73 m2 re-estimated by eGFRcys and eGFRcr-cys respectively. Serum cystatin C was significantly correlated with serum creatinine, MDRD, eGFRcr, eGFRcr-cys with the correlation coefficient being 0. 67, 0. 61, 0. 65, and 0. 77 respectively. Only the CKD staging based on eGFRcr, and eGFRcr-cys was positively related to renal graft loss risk. eGFRcr, and eGFRcr-cys could not be replaced each other, and only eGFRcr-cys. showed strong correlation with the other three equations. Conclusion As compared with others, eGFR （CKD-EPI-Creat ＋ C ysC） is more precise in estimating GFR and evaluating the renal graft loss risk.
出处
《中华器官移植杂志》
CAS
CSCD
2015年第6期339-342,共4页
Chinese Journal of Organ Transplantation
关键词
肾移植
血胱抑素C
肾小球滤过率
Kidney transplantation
Cystatin C
Glomerular filtration rate
