不同公式计算的估算肾小球滤过率对老年慢性肾脏病预后的分析

Prognostic analysis of chronic kidney disease in the elderly with estimated glomerular filtration rate by various equations

摘要:

目的 对比不同慢性肾脏病流行病合作研究(CKD-EPI)公式计算的估算肾小球滤过率(eGFR)在评估老年慢性肾脏病(CKD)患者预后中的诊断价值,并分析影响终点事件的危险因素。方法 选取2015年3月至2018年12月于北京友谊医院医疗保健中心行健康体检的具有4年连续资料的老年人共682例。采用基于肌酐(Cr)的CKD-EPI(CKD-EPICr)公式、基于胱抑素C(Cys)的CKD-EPI(CKD-EPICys)公式及基于Cr和Cys联合的CKD-EPI(CKD-EPICrCys)公式分别计算eGFR,评估各公式计算的eGFR对终点事件(全因死亡、心血管事件、急性肾损伤、快速肾功能下降)的诊断价值,分析影响预后的危险因素。采用SPSS 23.0软件进行数据处理。依据数据类型,组间比较分别采用t检验或χ²检验。受试者工作特征(ROC)曲线评估诊断价值,logistic回归分析影响预后的危险因素。结果 CKD-EPICys(AUC=0.692,P＜0.001)及CKD-EPICrCys(AUC=0.647,P＜0.001)公式计算的eGFR对终点事件有诊断价值,其中CKD-EPICys公式的诊断价值较高。CKD-EPICys与CKD-EPICrCys公式计算eGFR评估的终点事件的危险因素相同,均为尿白蛋白/肌酐比值(UACR)(OR=2.263,95%CI 1.359～3.771)、高血压(OR=1.679,95%CI 1.143～2.467)、贫血(OR=1.959,95%CI 1.245～3.084)及住院次数(OR=1.471,95%CI 1.321～1.637)。结论 CKD-EPICys公式计算的eGFR对老年CKD预后评估的诊断价值最有优势。UACR、贫血、高血压和住院次数是老年CKD患者发生终点事件的独立危险因素。

Abstract:

Objective To compare the diagnostic value of estimated glomerular filtration rate (eGFR) by various equations of Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) in evaluation of the prognosis in the elderly patients with chronic kidney disease (CKD), and analyze the risk factors for endpoint events. Methods A total of 682 old people, aged over 60 years, who had taken physical examination for 4 consecutive years in our health center during March 2015 to December 2018 were enrolled in this study. The eGFR was evaluated using CKD-EPI equations (CKD-EPICr, CKD-EPICys and CKD-EPICrCys) based on creatinine (Cr), cystatin C (Cys) and combination of them, respectively, and the obtained rate was evaluated for diagnostic value of endpoint events (all-cause death, cardiovascular events, acute kidney injury and rapid kidney function decline). The risk factors for these events were also analyzed. SPSS statistics 23.0 was used to analyze the data. According to the data types, Student′s t test or Chi-square test was used for comparison among groups. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value, and logistic regression analysis was employed to analyze the risk factors affecting the prognosis. Results ROC curve analysis showed that the eGFR from CKD-EPI_cys (AUC=0.692, P<0.001) and CKD-EPICrCys equations (AUC=0.647, P＜0.001) had diagnostic value for the occurrence of endpoint events, with that from the former equation higher. The eGFR from the above 2 equations also identified same independent risk factors for the occurrence of endpoint events, that is, ratio of urinary albumin to creatinine (UACR, OR=2.263, 95%CI 1.359-3.771), hypertension (OR=1.679,5%CI 1.143-2.467), anemia (OR=1.959,5%CI 1.245-3.084) and hospitalization frequency (OR=1.471,5%CI 1.321-1.637). Conclusion CKD-EPI_cys equation shows the greatest advantage in the diagnostic value of prognosis evaluation in the elderly with CKD. UACR, hypertension, anemia and hospitalization frequency are independent risk factors for endpoint events in them.