本文選題：估算腎小球濾過率評估方程　切入點：肌酐　出處：《上海交通大學》2015年碩士論文　論文類型：學位論文

【摘要】：背景與目的:糖尿病腎病是糖尿病患者常見的并發(fā)癥之一,并且也是終末期腎病最常見的單一原因。故準確評價這類人群的腎功能具有重要的意義。腎小球濾過率(GFR)是衡量腎功能的重要指標,采用99mTc標記的二乙三胺五乙酸(99mTc-DTPA)腎動態(tài)顯像法測定GFR開展較廣泛。但因其價格昂貴,不利于廣泛篩查以及基層醫(yī)院的推廣。目前基于普通人群所開發(fā)的通用估算腎小球濾過率(eGFR)方程在臨床廣泛使用,但一些特定人群由于其自身特點的影響,這些eGFR方程在這類人群中的性能亦會與普通人群有所不同。本研究對于不同腎小球濾過率評估方程在2型糖尿病患者中的適用性進行評價,以篩選出適用于中國2型糖尿病患者腎功能評估的計算方程。方法:選取2010至2014年住院的326名2型糖尿病患者。提取信息包括年齡、性別、身高、體重、肌酐、半胱氨酸蛋白酶抑制劑C(Cys C)。99mTc-DTPA測定的GFR(mGFR)作為參考標準。用Cockcroft-Gauh(C-G)方程(eGFR1方程)、腎臟病膳食改良試驗-4(MDRD-4)方程(eGFR2方程)、中國方程(eGFR3方程)、慢性腎臟病流行病學協(xié)作組(CKD-EPI)肌酐方程(eGFR4方程)、CKD-EPI Cys C方程(eGFR5方程)、CKD-EPI Cys C肌酐聯(lián)合方程(eGFR6方程)、Feng Cys C方程(eGFR7方程)以及Feng Cys C肌酐聯(lián)合方程(eGFR8方程)來估測GFR。各eGFR方程與mGFR之間的比較使用配對t檢驗、Pearson相關性分析。各eGFR方程間的比較使用Bland-Altman分析、偏差、精確度、準確率和受試者工作曲線分析(ROC)。使用Bland-Altman方法評價一致性限度專業(yè)值界定為60mL/(min·1.73 m2)。偏差=eGFR與mGFR差值的平均值,精確度=偏差的標準差,準確率=eGFR數(shù)值落在mGFR 10%、30%、50%范圍的病例百分比。所有統(tǒng)計學分析在SPSS 19.0和MedCalc 12.7中完成。結果:總?cè)巳簃GFR 60.46±27.20mL/(min·1.73 m2)。八個eGFR方程中只有eGFR5方程[61.29±30.39 mL/(min·1.73 m2),P=0.450]與mGFR無統(tǒng)計學差異,其余七個方程均高估了患者的GFR水平。Bland-Altman分析結果顯示八個方程的一致性限度均超過了規(guī)定的專業(yè)值,其中eGFR6[66.1(-41.1~25.0)mL/(min·1.73 m2)]一致性限度最小。eGFR5方程在八個方程中偏差最小[-0.83mL/(min·1.73 m2)]。在精確度表現(xiàn)上,eGFR4方程[18.35m L/(min·1.73 m2)]、eGFR5方程[19.75m L/(min·1.73 m2)]、eGFR6方程[16.84m L/(min·1.73 m2)]、eGFR7方程[21.67mL/(min·1.73 m2)]性能較好。在準確率表現(xiàn)上,eGFR5方程和eGFR6方程有較高的10%符合率(分別為24.54%和26.99%)、30%符合率(分別為68.71%和65.64%)和50%符合率(分別為87.42%和84.36%)。而在ROC分析中,八個方程中eGFR6方程(0.905)和eGFR4方程(0.891)ROC曲線下面積最大。結論:在中國2型糖尿病患者中eGFR5和eGFR6的診斷效能較高,優(yōu)于其余六個方程。所有方程的一致性表現(xiàn)均超過了專業(yè)界值,故這兩個方程在常規(guī)應用于臨床前仍需進一步修正。
[Abstract]:Background and objective: diabetic nephropathy is one of the common complications of diabetes, and is also the single cause of end-stage renal disease is the most common. It has important significance in renal function evaluation of this kind of people. The glomerular filtration rate (GFR) is an important indicator of renal function, using 99mTc labeled two B three (five amino acetic acid 99mTc-DTPA) renal dynamic imaging method for the determination of GFR carried out widely. But because the price is expensive, is not conducive to the promotion of extensive screening and primary hospital. The general is currently based on the estimated glomerular filtration rate of the general population development equation (eGFR) is widely used in clinic, but the specific population due to its own characteristics, the performance of the eGFR equation in this population will also be different from ordinary people. This study for different GFR estimation equations in applicability in patients with type 2 diabetes were evaluated by sieve Choose the suitable calculation equation on renal function in patients with type 2 diabetes China evaluation. Methods: 326 patients with type 2 diabetes hospitalized from 2010 to 2014. The extraction information including age, gender, height, body weight, serum creatinine, Cystatin C (Cys C.99mTc-DTPA) determination of GFR (mGFR) as the reference standard. Cockcroft-Gauh (C-G) equation (eGFR1 equation), MDRD -4 (MDRD-4) equation (eGFR2 equation), China equation (eGFR3 equation), chronic kidney disease epidemiology collaboration group (CKD-EPI) creatinine equation (eGFR4 equation), the CKD-EPI Cys C equation (eGFR5 equation), CKD-EPI Cys C (creatinine combined equation eGFR6, Feng Cys) equation C equation (eGFR7 equation) and the Feng Cys C equation (eGFR8 equation) were combined to estimate the comparison between GFR. and mGFR by eGFR equation matching t test, Pearson correlation analysis. The comparison between the Bland eGFR equation -Altman analysis, bias, precision, accuracy analysis and receiver operating curve (ROC). The method of Bland-Altman to evaluate the consistency of the limit value is defined as the use of professional 60mL/ (min 1.73 m2). The average deviation of the =eGFR and mGFR difference value, accuracy = deviation standard deviation, the accurate rate of fall in mGFR 10% = eGFR 30%, 50% cases, percentage range. All the statistical analysis in SPSS 19 and MedCalc 12.7 in complete. Results: the total population of mGFR 60.46 + 27.20mL/ (min 1.73 m2). Eight eGFR equations only eGFR5 equation [61.29 + 30.39 mL/ (min 1.73 m2), no significant difference between P= 0.450] and mGFR, the rest the seven equations are overestimated in the level of GFR.Bland-Altman analysis of the patients showed consistency limit of eight equations are more than the required professional values, including eGFR6[66.1 (-41.1~25.0) mL/ (min - 1.73 m2)] consistency limit minimum.EGFR5 equation in the eight equation the deviation Small [-0.83mL/ (min 1.73 m2). The accuracy of performance, the eGFR4 equation [18.35m L/ (min - 1.73 m2)], eGFR5 L/ equation [19.75m (min - 1.73 m2)], eGFR6 L/ equation [16.84m (min - 1.73 m2)], eGFR7 equation [21.67mL/ (min - 1.73 m2)] in good performance. The accuracy of the performance, the eGFR5 equation and the eGFR6 equation has a higher coincidence rate of 10% (24.54% and 26.99%), the coincidence rate of 30% (68.71% and 65.64%) and the coincidence rate of 50% (87.42% and 84.36%). In the ROC analysis, the eGFR6 equation of the eight equation and the eGFR4 equation (0.905) (0.891) the largest area under the ROC curve. Conclusion: in Chinese eGFR5 and eGFR6 in patients with type 2 diabetes and the diagnostic efficiency is higher, better than the other six equations. The consistency of all equations are more than professional values, so these two equations in conventional before clinical application needs further modification.

【學位授予單位】：上海交通大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R587.2;R692.9

【參考文獻】

相關期刊論文 前10條

1 常虹;談敏;葉山東;;腎小球濾過率評估方程對我國糖尿病合并慢性腎臟疾病患者的應用評價[J];中國糖尿病雜志;2013年05期

2 顧紅霞;秦利;石群;蘇青;;不同腎小球濾過率評估方程在2型糖尿病患者中的適用性[J];中華內(nèi)分泌代謝雜志;2012年10期

3 李麗;楊帆;毛客自;陸怡德;;糖尿病患者腎小球濾過率評估方法的臨床應用研究[J];檢驗醫(yī)學;2012年08期

4 李明;陳慧卿;劉迅;唐驊;王成;李燦明;趙文波;婁探奇;;臨床常用腎小球濾過率評估方程在2型糖尿病患者中的效能比較[J];中華糖尿病雜志;2012年06期

5 楊帆;李麗;孫愛華;馬蔚蕓;陸怡德;;基于半胱氨酸蛋白酶抑制素C建立的腎小球濾過率估算公式對于2型糖尿病患者腎功能的評估價值[J];診斷學理論與實踐;2012年03期

6 張萌;黃清梅;簡小金;方紅娟;楊金奎;;血糖水平對2型糖尿病患者腎小球濾過率及其評估方程的影響[J];中國糖尿病雜志;2011年08期

7 張紅霞;原杰;柳潔;賈偉平;;三種腎小球濾過率評估方程對早期糖尿病腎病的診斷價值比較[J];中華腎臟病雜志;2011年05期

8 王文霞;賈偉平;包玉倩;李青;陸惠娟;項坤三;;腎小球濾過率評價糖尿病患者腎功能的意義及方法學比較[J];中華醫(yī)學雜志;2007年48期

9 全國eGFR課題協(xié)作組;;MDRD方程在我國慢性腎臟病患者中的改良和評估[J];中華腎臟病雜志;2006年10期

10 史浩;陳楠;張文;任紅;徐耀文;沈平雁;王偉銘;俞海瑾;李曉;馮曉蓓;;簡化MDRD公式預測慢性腎病患者腎小球濾過率的應用評價及校正[J];中國實用內(nèi)科雜志;2006年09期

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