Gerhardt Thomas, Pöge Uwe, Stoffel-Wagner Birgit, Ahrendt Manuela, Wolff Martin, Spengler Ulrich, Palmedo Holger, Sauerbruch Tilman, Woitas Rainer P
Department of Internal Medicine I, University of Bonn, Bonn, Germany.
Liver Transpl. 2006 Nov;12(11):1667-72. doi: 10.1002/lt.20881.
Early detection of renal dysfunction in patients after orthotopic liver transplantation is important. Creatinine-based equations to estimate glomerular filtration rate (GFR) were found to be less accurate in liver transplant recipients than in their original populations. Since cystatin C (CysC) is independent from muscle mass and hepatic biosynthesis, we evaluated the diagnostic accuracy of 3 CysC-based equations (Larson, Hoek, and Filler formulae) that are based on the same CysC method as that of our center in comparison to the abbreviated creatinine-based modification of diet in renal disease (MDRD) formula in 59 liver transplant recipients. "True GFR" was measured by 99mTc-diethylene triamine pentaacetic acid ((99m)Tc-DTPA) clearance. Neither correlation with the GFR (correlation coefficients: 0.594-0.640) nor precision (root mean square error: 15.7-18.17 mL/min/1.73 m(2)) differed significantly between the tested formulae. The biases of the Hoek and Larsson formulae were significantly smaller than those of the MDRD and Filler equations (-0.1 and -2.3 vs. 10.1 and 7.9 mL/min/1.73 m(2), respectively; P </= 0.0023). Mean estimates of MDRD (61.9 +/- 21.4 mL/min/1.73 m(2)) and Filler (61.2 +/- 22.1 mL/min/1.73 m(2)) differed significantly from the measured GFR (52.3 +/- 17.5 mL/min/1.73 m(2); P < 0.005), whereas Larsson and Hoek did not (49.5 +/- 20.2 and 51.4 +/- 17.9 mL/min/1.73 m(2), respectively). Accuracy within 30% and 50% of the true GFR was best for the Hoek (76.3% and 93.2%) formula, albeit not significantly different from MDRD (64.4% and 83.1%). Taken together, these data show the best overall performance for GFR estimates derived from the Hoek equation with respect to bias, precision, and accuracy.
原位肝移植患者肾功能障碍的早期检测很重要。基于肌酐的估算肾小球滤过率（GFR）的公式在肝移植受者中不如在其原人群体中准确。由于胱抑素C（CysC）独立于肌肉量和肝脏生物合成，我们评估了3种基于CysC的公式（拉森公式、赫克公式和菲勒公式）的诊断准确性，这些公式与我们中心采用相同的CysC检测方法，同时与59例肝移植受者中简化的基于肌酐的肾病饮食改良（MDRD）公式进行比较。“真实GFR”通过99mTc-二乙三胺五乙酸（（99m）Tc-DTPA）清除率来测定。各测试公式与GFR的相关性（相关系数：0.594 - 0.640）以及精密度（均方根误差：15.7 - 18.17 mL/min/1.73 m²）均无显著差异。赫克公式和拉森公式的偏差显著小于MDRD公式和菲勒公式（分别为-0.1和-2.3 vs. 10.1和7.9 mL/min/1.73 m²；P≤0.0023）。MDRD公式（61.9±21.4 mL/min/1.73 m²）和菲勒公式（61.2±22.1 mL/min/1.73 m²）的平均估算值与测得的GFR（52.3±17.5 mL/min/1.73 m²）有显著差异（P < 0.005），而拉森公式和赫克公式则无显著差异（分别为49.5±20.2和51.4±17.9 mL/min/1.73 m²）。赫克公式在真实GFR的30%和50%范围内的准确性最佳（分别为76.3%和93.2%），尽管与MDRD公式（分别为64.4%和83.1%）无显著差异。综上所述，这些数据表明，就偏差、精密度和准确性而言，源自赫克公式的GFR估算总体表现最佳。
