基于肌酐与胱抑素的肾小球滤过率估算方程对人群肾功能分期的评价及应用

申志祥; 刘宇; 刘敏; 郑卉; 吴晓军; 沈冲

Abstract

申志祥,刘宇,刘敏,郑卉,吴晓军,沈冲.基于肌酐与胱抑素的肾小球滤过率估算方程对人群肾功能分期的评价及应用[J].Chinese journal of Epidemiology,2017,38(11):1557-1562

基于肌酐与胱抑素的肾小球滤过率估算方程对人群肾功能分期的评价及应用

Evaluation and application of estimation of glomerular filtration rate based on serum creatinine and cystatin C in renal function staging

Received:March 20, 2017

DOI：10.3760/cma.j.issn.0254-6450.2017.11.024

KeyWord: 肾小球滤过率慢性肾脏病流行病学

English Key Word: Glomerular filtration rate Chronic kidney disease Epidemiology

FundProject:镇江市社会发展指导性项目（FZ2015064）；句容市科技局民生科技计划项目（SF2016896226）

Author Name	Affiliation	E-mail
Shen Zhixiang	Health Management Center, Jiangsu Provincial Geriatric Hospital, Nanjing 210024, China
Liu Yu	Jurong County Center for Disease Control and Prevention, Jurong 212402, China
Liu Min	Jurong County Center for Disease Control and Prevention, Jurong 212402, China
Zheng Hui	Health Management Center, Jiangsu Provincial Geriatric Hospital, Nanjing 210024, China
Wu Xiaojun	Jurong County Center for Disease Control and Prevention, Jurong 212402, China
Shen Chong	Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 210029, China Department of Clinical Epidemiology, Jiangsu Provincial Geriatric Hospital, Nanjing 210024, China	sc100@126.com

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Abstract:

目的评价慢性肾脏病（CKD）流行病学协作组（CKD-EPI）2009方程、CKD-EPI2012方程及简化MDRD（modification of diet in renal disease）方程在CKD分期中的作用及对常见心血管疾病的预测价值。方法选择2015年9-11月江苏省句容地区11 151例成年人进行问卷调查，监测血肌酐（Scr）及胱抑素（Cys-C）水平，用上述三种方程评估肾小球滤过率（GFR）。结果对慢性肾功能不全者，在判断肾功能分期上，CKD-EPI（2009、2012）方程均与MDRD方程有较好一致性（P<0.001），其中CKD-EPI2012方程与CKD-EPI2009方程判断结果有极高一致性。而在无慢性肾病史人群中，MDRD、CKD-EPI2012方程均与CKD-EPI2009方程判断肾功能分期结果有较高一致性（P<0.001），Kappa值分别为0.662和0.654；CKD-EPI2012方程与MDRD方程分期结果仅有中度一致性。在所有研究对象中，采用Bland-Altman方法分析，MDRD方程、CKD-EPI2009方程与CKD-EPI2012方程对CKD分期结果具有较好的一致性。≥ 70岁人群中CKD-EPI（2009、2012）方程与MDRD方程对CKD分期的一致性高于<70岁人群，且男性高于女性。CKD-EPI（2009、2012）方程计算GFR预测高血压的AUC值高于MDRD方程预测结果；CKD-EPI2012方程计算GFR预测脑卒中和冠心病的AUC值均高于MDRD方程预测结果，而CKD-EPI2009方程与MDRD方程计算的GFR预测结果的差异无统计学意义。结论 MDRD方程与CKD-EPI（2009、2012）方程对CKD分期结果具有中高度一致性，但后者估算的GFR对心血管预测价值高于前者。

English Abstract:

Objective To evaluate the accordance of chronic kidney disease (CKD) staging between the CKD-EPI2009 equation, the CKD-EPI2012 equation and the modification of diet in renal disease (MDRD) equation and compare the predictive value of common cardiovascular disease. Methods A total of 11 151 adults from Jurong area, Jiangsu province, were surveyed from September to November in 2015 and their serum creatinine and cystatin C were detected. The glomerular filtration rate (GFR) was estimated by three equations. Results In the individuals with history of chronic renal insufficiency, the results of CKD staging of CKD-EPI2009 equation and CKD-EPI2012 equation were all consistent with that of MDRD equation (P<0.001), and the consistence between CKD-EPI2012 equation and CKD-EPI2009 equation was even higher. In the people without history of CKD, the results of CKD staging of CKD-EPI2009 equation and CKD-EPI2012 equation were also highly consistent with the results of MDRD equation (P<0.001) and Kappa values were 0.662 and 0.654 respectively whilst the results of CKD staging estimated by CKD-EPI2012 equation and MDRD equation were only moderately consistent (Kappa=0.436, P<0.001). In the whole observational population, the CKD staging results of MDRD equation, CKD-EPI2009 equation and CKD-EPI2012 equation had a good consistency evaluated by Band-Altman method. The consistency of CKD staging between CKD-EPI (2009, 2012) equation and MDRD equation was higher in ≥ 70 years old group than that in <70 years old group as well as in males than in females. For predicting hypertension, the AUCs of CKD-EPI equations calculated GFRs were significantly higher than that of MDRD equation; the AUCs of CKD-EPI2012 equation calculated GFR for predicting stroke and coronary heart disease were higher than that of MDRD equations whereas no significant difference in GFR prediction result was found between CKD-EPI2009 equation and MDRD equation. Conclusion MDRD equation and CKD-EPI equation for GFR estimation have high consistency in CKD staging whilst the predictive value of chronic cardiovascular disease by CKD-EPI equation estimated GFR was higher than that of MDRD equation.

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