不同公式在我国老年肾功能减退研究中的应用

Different equations for estimated glomerular filtration rate in assessment of kidney function decline in Chinese elderly

摘要:

目的 探讨不同公式评估目标老年人群肾功能变化的差异性。方法 搜集2008年3月至2012年3月连续4年在南京医科大学第一附属医院干部门诊进行健康体检的老年人111例，年龄60～94岁，男性53例，女性58例。随访并记录2008年3月和2012年3月两个时间点的相关生化指标值。应用4种肾小球滤过率评估公式（CKD-EPIscr-cys，BISscr，BISscr-cys及Cscr-cys）分别得到估算的肾小球滤过率（eGFR）。结果 男性受试者随访前的年龄、收缩压、体质量指数（BMI）、血肌酐和尿酸水平均明显高于女性（P＜0.001）。4年后受试者的血尿素氮、肌酐、尿酸较基线水平均明显升高（P＜0.001），但胱抑素（Cys C）下降（P＜0.001）。4种不同公式的eGFR均明显降低（P＜0.001），但下降的幅度不完全一致，其中以Cscr-cys评估公式的下降幅度最小。女性eGFR下降速率与男性相比差异无统计学意义。结论 在老年人群中，eGFR随着年龄增长而下降，但不同的评估方程下降的幅度不同，因此，应用公式计算老年人的eGFR变化时仍需谨慎。

Abstract:

Objective To determine the differences in renal function evaluation with different equations in the Chinese elderly. Methods A total of 111 aged people (60 to 94 years old, 53 males and 58 females) who took physical examination in the First Affiliated Hospital of Nanjing Medical University for 4 consecutive years from March 2008 to March 2012 were recruited in this study. Their baseline data in March 2008 and follow-up data in March 2012 were recorded. Four different equations, CKD-EPIscr-cys, BISscr, BISscr-cys and Cscr-cys, were used to evaluate their estimated glomerular filtration rate (eGFR) at the 2 time points. Results The age, systolic blood pressure, body mass index, serum creatinine, and uric acid were significantly higher in the males than in the females (P＜0.001). Their serum urea nitrogen, creatinine and uric acid were all increased in the participants when compared with baseline data (P＜0.001), while serum cystatin C(Cys C) decreased (P＜0.001). Their eGFR assessed by the 4 different formulas were obviously decreased (P＜0.001), but the declines had differences. The eGFR by Cscr-cys equation had the minimal reduction. The declining of eGFR had no significant differences between the male and female participants. Conclusion In the elderly, eGFR is declined with age, but the fall is different when evaluated by different equations. Physicians should be careful in selecting the equations for eGFR for the elderly.