华西医学

华西医学

慢性肾脏病早期筛查的临床应用评价

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目的分析常用肾功能指标在不同年龄段受试者中对慢性肾脏病(chronic kidney disease,CKD)的筛查性能,探索中国人群 CKD 筛查方案。方法2016 年 5 月—2017 年 10 月,将于四川省骨科医院或绵阳市中心医院就诊的成人受试者 2 131 例按年龄段分成 3 组:18~39 岁(A 组,n=278)、40~64 岁(B 组,n=1 167)、≥65 岁(C 组,n=686)。测定其血清肌酐(serum creatinine,SCr)、尿素和胱抑素 C(cystatin C,CysC),计算估计肾小球滤过率(estimated glomerular filtration rate,eGFR),测定尿液白蛋白、总蛋白和肌酐,并计算得出尿白蛋白/肌酐比(albumin to creatinine ratio,ACR)和总蛋白/肌酐比(protein to creatinine ratio,PCR)。按改善全球肾脏病预后组织(Kidney Disease: Improving Global Outcomes,KDIGO)指南(2012 年版)诊断 CKD。然后用受试者工作特征(receiver operating characteristic,ROC)曲线分析各观察指标对 CKD 的诊断性能。结果A 组、B 组和 C 组患者 CKD 的患病率分别为 10.8%(30/278)、16.4%(191/1 167)和 45.8%(314/686),差异有统计学意义(χ2=233.525,P<0.001)。各年龄组中,6 个肾功能指标水平在 CKD 和非 CKD 受试者间的差异均有统计学意义(P<0 05="" roc="" a="" egfr="" cysc="" scr="" ckd="" acr="" pcr="">eGFR 或 CysC>尿素或 SCr(P<0 05="" 3="" kdigo="" acr="" pcr="" b="" 0="" 915="" 0="" 914="">A 组(0.885、0.890)>C 组(0.841、0.846);而 eGFR 在各年龄段组的诊断性能:C 组(0.807)>B 组(0.728)>A 组(0.696)。其最佳判断界值,ACR 和 PCR 低于而 eGFR 高于 KDIGO 推荐的医学决定水平。结论肾功能指标肌酐正常情况下,ACR 是筛查 CKD 的首选指标,eGFR 可进一步提高诊断率,尤其是 65 岁以上受试者。

ObjectiveTo evaluate the screening performance of commonly used renal function indicators for chronic kidney disease (CKD) in subjects of different ages, so as to explore the appropriate screening regimen for Chinese population.MethodsA total of 2 131 adult subjects in Sichuan Orthopaedic Hospital or Mianyang Central Hospital from May 2016 to October 2017 were selected. They were divided into three groups according to age: group A (18–39 years, n=278), group B (40–64 years, n=1 167), and group C (≥65 years, n=686). Serum levels of creatinine (SCr), urea, and cystatin C [CysC; to calculate estimated glomerular filtration rate (eGFR) based on this index], as well as urine levels of albumin, total protein and creatinine were measured, and urine albumin to creatinine ratio (ACR) and urine protein to creatinine ratio (PCR) were calculated respectively. CKD was diagnosed according to the Kidney Disease: Improving Global Outcomes (KDIGO) Guideline (2012 Edition). The receiver-operating characteristic (ROC) curve analysis was finally performed to investigate the diagnostic performance of each indicator for CKD.ResultsThe prevalences of CKD in group A, B, and C were 10.8% (30/278), 16.4% (191/1 167), and 45.8% (314/686), respectively, and the difference among these groups was statistically significant (χ2=233.525, P<0.001). In addition, the levels of the six renal function indicators between CKD and non-CKD subjects also had statistically significant differences in different age groups (P<0 05="" otherwise="" roc="" curve="" analysis="" revealed="" that="" the="" diagnostic="" values="" of="" these="" indicators="" were:="" acr="" or="" pcr=""> eGFR or CysC > serum urea or SCr (AllP<0 05="" except="" that="" egfr="" cysc="" serum="" urea="" and="" scr="" in="" group="" a="" assessed="" the="" similar="" diagnostic="" performance="" among="" the="" three="" indicators="" recommended="" by="" kdigo="" guideline="" the="" diagnostic="" performances="" of="" acr="" and="" pcr="" in="" different="" age="" groups="" were:="" group="" b="" 0="" 915="" 0="" 914=""> group A (0.885, 0.890) > group C (0.841, 0.846), while the diagnostic performance of eGFR was group C (0.807) > group B (0.728) > group A (0.696). The best boundary values of ACR and PCR were lower while the value of eGFR was higher than the corresponding KDIGO recommended medical decision levels.ConclusionsACR is the first choice for screening CKD when the renal function index creatinine is normal. Moreover, eGFR can further improve the diagnostic value, especially in subjects over 65 years old.

关键词: 慢性肾病; 尿白蛋白肌酐比; 尿总蛋白肌酐比; 估计肾小球滤过率; 胱抑素C

Key words: Chronic kidney disease; Albumin to creatinine ratio; Protein to creatinine ratio; Estimated glomerular filtration rate; Cystatin C

引用本文: 黄玉霞, 杨渝伟, 唐敏, 刘小莉, 桑阳, 徐艺筝, 郭莉, 俸家富. 慢性肾脏病早期筛查的临床应用评价. 华西医学, 2018, 33(12): 1507-1512. doi: 10.7507/1002-0179.201811115 复制

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