Robinson B A, Frampton C M, Colls B M, Atkinson C H, Fitzharris B M
Oncology Service, Christchurch Hospital, New Zealand.
Aust N Z J Med. 1990 Oct;20(5):657-62. doi: 10.1111/j.1445-5994.1990.tb00395.x.
In patients with cancer treated with cisplatin, carboplatin or methotrexate creatinine clearance calculated using the Cockcroft-Gault formula was compared with measured clearance and with the glomerular filtration rate. In 106 patients the average squared difference for calculated and 24 hour urine creatinine clearance was 0.288, n = 606; and for calculated creatinine clearance and glomerular filtration rate (measured using diethylenetriaminepenta-acetic acid, DTPA), 0.212, n = 34. On 35 of 606 occasions (6%) in 18 patients (17%), the calculated clearance overestimated the 24-hour urine creatinine clearance when it was less than 1 mL/s. In all but one patient, this was explained by factors leading to renal impairment (seven patients) or overestimation of clearance (ascites in two patients) or by an isolated low value of 24-hour urine creatinine clearance (eight patients). Declining renal function with increasing total dose of cisplatin was detected by both calculated and 24-hour urine creatinine clearance in patients with germ cell tumours. Derivation of an equation to predict creatinine clearance showed a linear association with plasma creatinine concentration, patient age, weight and gender. Variability in cancer patients was similar to that in the original Cockcroft-Gault study. Calculation of creatinine clearance can be used in cancer patients to monitor treatment with renally-eliminated chemotherapy agents.
在接受顺铂、卡铂或甲氨蝶呤治疗的癌症患者中，使用Cockcroft-Gault公式计算的肌酐清除率与测量的清除率以及肾小球滤过率进行了比较。在106例患者中，计算的肌酐清除率与24小时尿肌酐清除率的平均平方差为0.288，n = 606；计算的肌酐清除率与肾小球滤过率（使用二乙烯三胺五乙酸，DTPA测量）的平均平方差为0.212，n = 34。在606次测量中有35次（6%），在18例患者（17%）中，当计算的清除率小于1 mL/s时，其高估了24小时尿肌酐清除率。除1例患者外，所有这些情况均由导致肾功能损害的因素（7例患者）、清除率高估（2例患者有腹水）或24小时尿肌酐清除率孤立低值（8例患者）所解释。在生殖细胞肿瘤患者中，通过计算的肌酐清除率和24小时尿肌酐清除率均检测到随着顺铂总剂量增加肾功能下降。预测肌酐清除率的方程推导显示与血浆肌酐浓度、患者年龄、体重和性别呈线性关联。癌症患者的变异性与原始Cockcroft-Gault研究中的相似。肌酐清除率的计算可用于癌症患者以监测肾排泄化疗药物的治疗。
