老年患者肾功能评估：基于肌酐的公式与使用99mTc-二乙三胺五乙酸的同位素方法的性能比较

Evaluation of renal function in elderly patients: performance of creatinine-based formulae versus the isotopic method using 99mTc-diethylene triamine pentaacetic acid.

作者信息

Maioli Claudio, Cozzolino Mario, Gallieni Maurizio, Del Sole Angelo, Tagliabue Luca, Strinchini Aldo, Gaito Sabrina, Lecchi Michela, Cusi Daniele, Lucignani Giovanni

机构信息

aDepartments of Health Sciences bComputer Science, University of Milan cNephrology and Dialysis Unit, San Carlo Borromeo Hospital dNephrology and Dialysis Unit eNuclear Medicine Unit, San Paolo Hospital, Milan, Italy.

出版信息

Nucl Med Commun. 2014 Apr;35(4):416-22. doi: 10.1097/MNM.0000000000000066.

DOI:10.1097/MNM.0000000000000066

PMID:24457319

Abstract

INTRODUCTION

Measurement of the glomerular filtration rate (GFR) is recognized worldwide as the most accurate way of assessing kidney function. The prevalence of impaired renal function increases with advancing age. In this study we compared the clinical formulae Cockcroft-Gault (CG), isotope dilution mass spectrometry-modification of diet in renal disease (IMDS-MDRD) and chronic kidney disease epidemiology collaboration (CKD-EPI) with (99m)Tc-diethylene triamine pentaacetic acid ((99m)Tc-DTPA) in elderly patients over and under the age of 70 years in an attempt to establish which formula produces the best measurement of renal function in this population.

MATERIALS AND METHODS

Patients were randomly selected from two age groups [<70 years (n = 37) and ≥ 70 years (n = 39)]. Two plasma samples were collected at 60 and 180 min after injection of (99m)Tc-DTPA, and the GFR was calculated applying Charles D. Russell's two-sample method.

RESULTS

In patients younger than 70 years, no statistically significant difference was found between GFR evaluated with (99m)Tc-DTPA and GFR obtained using the other methods.In patients aged at least 70 years, no statistically significant difference was found between GFR evaluated with (99m)Tc-DTPA and GFR evaluated using the CG real weight formula. Conversely, statistically significant differences were found between GFR evaluated with (99m)Tc-DTPA and GFR obtained using the CG normalized weight (P = 0.002), IMDS-MDRD (P = 0.024) and CKD-EPI (P = 0.028) formulae.

DISCUSSION AND CONCLUSION

In patients older than 70 years, the use of the two 'classical' formulae (IMDS-MDRD and CKD-EPI) overestimated GFR in stage III CKD (GFR 30-59 ml/min) when compared with the gold standard (99m)Tc-DTPA method. Thus, in patients aged 70 years and above only the CG real weight formula provided unbiased results comparable to (99m)Tc-DTPA. In conclusion, in elderly patients, GFR measured using CKD-EPI and IMDS-MDRD serum creatinine-based formulae may be overestimated compared with that measured using (99m)Tc-DTPA GFR.

摘要

引言

肾小球滤过率（GFR）的测定被公认为是评估肾功能的最准确方法。肾功能受损的患病率随年龄增长而增加。在本研究中，我们将Cockcroft-Gault（CG）公式、同位素稀释质谱法-肾脏病膳食改良（IMDS-MDRD）公式和慢性肾脏病流行病学协作组（CKD-EPI）公式与70岁及以上和70岁以下老年患者的（99m）锝-二乙三胺五乙酸（（99m）Tc-DTPA）进行比较，试图确定哪种公式能对该人群的肾功能进行最佳测量。

材料与方法

从两个年龄组中随机选取患者[<70岁（n = 37）和≥70岁（n = 39）]。在注射（99m）Tc-DTPA后60分钟和180分钟采集两份血浆样本，并应用查尔斯·D·拉塞尔的双样本法计算GFR。

结果

在70岁以下患者中，用（99m）Tc-DTPA评估的GFR与用其他方法获得的GFR之间未发现统计学上的显著差异。在70岁及以上患者中，用（99m）Tc-DTPA评估的GFR与用CG实际体重公式评估的GFR之间未发现统计学上的显著差异。相反，用（99m）Tc-DTPA评估的GFR与用CG标准化体重公式（P = 0.002）、IMDS-MDRD公式（P = 0.024）和CKD-EPI公式（P = 0.028）获得的GFR之间发现了统计学上的显著差异。

讨论与结论

在70岁以上患者中，与金标准（99m）Tc-DTPA方法相比，使用两种“经典”公式（IMDS-MDRD和CKD-EPI）在III期慢性肾脏病（GFR 30 - 59 ml/分钟）中高估了GFR。因此，在70岁及以上患者中，只有CG实际体重公式能提供与（99m）Tc-DTPA相当的无偏结果。总之，在老年患者中，与用（99m）Tc-DTPA GFR测量相比，使用基于CKD-EPI和IMDS-MDRD血清肌酐的公式测量的GFR可能被高估。