使用51Cr-乙二胺四乙酸测量肾小球滤过率：布勒希纳-莫特森校正前还是校正后进行体表面积标准化？
Measuring glomerular filtration rate using 51Cr-EDTA: body surface area normalization before or after Bröchner-Mortensen correction?
作者信息
Pottel Hans, Hoste Liesbeth, De Waele Liesbeth, Braat Elke, Baete Kristof, Goffin Karolien, Levtchenko Elena, Gheysens Olivier
机构信息
Departments of aPublic Health and Primary Care at Kulak bDevelopment and Regeneration at Kulak, KU Leuven Kulak, Kortrijk Departments of cPaediatric Neurology dPaediatric Nephrology eNuclear Medicine, University Hospital Leuven Departments of fDevelopment and Regeneration gImaging and Pathology, KU Leuven, Leuven, Belgium.
出版信息
Nucl Med Commun. 2014 Nov;35(11):1150-5. doi: 10.1097/MNM.0000000000000186.
BACKGROUND
Guidelines for measuring glomerular filtration rate (GFR) using Cr-EDTA require normalizing of GFR for body surface area (BSA) before applying the Bröchner-Mortensen (BM) correction. The guideline explicitly mentions the importance of performing BSA normalization before BM correction and that this is particularly important in children in whom the effects of BSA normalization are largest.
MATERIALS AND METHODS
We theoretically showed that the order of applying BM correction and BSA indexing is indeed important for patient populations having a low BSA and a high slow GFR. We then compared the exact GFR, obtained from the double-exponential concentration-time curve in Duchenne muscular dystrophy (DMD) patients, with the GFR obtained from the slow compartment method using the BM correction.
RESULTS
The median GFR for the 20 DMD patients obtained from the BSA-BM order deviates 5.40% from the exact GFR (P=0.0006), whereas the median GFR obtained from the BM-BSA order deviates only -0.05% (P>0.05) from the exact GFR, resulting in a median of differences of 5.50% between the two methods (P<0.0001).
CONCLUSION
The correct order of application in this DMD population should be BM correction first, followed by BSA indexing, and not vice versa. In general, the order of applying the BM correction and BSA normalization becomes more important with increasing slow GFR and extreme low BSA. The order of application is of less importance for people with normal BSA and/or normal GFR.
背景
使用铬标记乙二胺四乙酸（Cr-EDTA）测量肾小球滤过率（GFR）的指南要求，在应用布罗克纳 - 莫滕森（BM）校正之前，需根据体表面积（BSA）对GFR进行标准化。该指南明确提到在进行BM校正之前进行BSA标准化的重要性，并且这在儿童中尤为重要，因为BSA标准化的影响在儿童中最为显著。
材料与方法
我们从理论上表明，对于体表面积低且慢GFR高的患者群体，应用BM校正和BSA指数化的顺序确实很重要。然后，我们将从杜兴肌营养不良症（DMD）患者的双指数浓度 - 时间曲线获得的精确GFR与使用BM校正的慢室法获得的GFR进行了比较。
结果
按照BSA - BM顺序获得的20例DMD患者的中位GFR与精确GFR相差5.40%（P = 0.0006），而按照BM - BSA顺序获得的中位GFR与精确GFR仅相差 -0.05%（P>0.05），两种方法的中位差异为5.50%（P<0.0001）。
结论
在这个DMD人群中，正确的应用顺序应该是先进行BM校正，然后进行BSA指数化，而不是相反。一般来说，随着慢GFR增加和体表面积极低，应用BM校正和BSA标准化的顺序变得更加重要。对于体表面积正常和/或GFR正常的人来说，应用顺序不太重要。
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