Liu Yan, Wang Qi, Xie Xin, Gao Rui, Yang Aimin, Liang Yiqian, Jia Xi, Li Xinru, Yang Lulu, Zhang Jing, Qiao Hongmei, Xue Jianjun
Department of Nuclear Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Radiotherapy and Oncology, Baoji High-Tech Hospital, Baoji, China.
Transl Androl Urol. 2022 Nov;11(11):1535-1543. doi: 10.21037/tau-22-614.
Gates' analysis method for kidney depth (KD) calculation is the only way to determine the glomerular filtration rate (GFR) of the kidney in clinical practice, which posits that the influence of KD on the GFR is more important than other factors. Computed tomography (CT) measurement of the donor KD can improve the accuracy of GFR measurement by Gates' method but will also increase the radiation exposure of kidney transplantation donors. Thus, it is particularly important to establish an accurate empirical formula for KD measurement that is more consistent with the real KD.
In total, 326 potential renal transplantation donors were enrolled in this study. Among these, 167 donors were assigned to the training set to estimate the regression formula of KD measured by CT. The remaining 159 donors were included in the validation set to verify the regression formula. The KD measured by CT and its corresponding GFR was taken as the reference standard. The performances of formulas were then compared.
There was no significant statistical difference between the CT-measured KD and the current fitting, Li Q, and Xue JJ formulas (P>0.05). However, significant differences were observed between the KDs calculated using the Taylor, Ma G, and Uchiyama formulas and the CT-measured reference standard KD (P<0.05). Furthermore, there was no notable difference in the GFR and GFR corresponding to the CT-measured KD with that of the fitting, Ma G, and Xue JJ formulas (P>0.05). There were also marked differences in the GFR corresponding to the Li Q's formula (P<0.05), and in the GFR between other estimation methods and the CT measurement (P<0.05).
The fitting formula established in this study can play a more important role if an accurate measurement method of the body thickness at the level of the hilum on the body surface can be found.
盖茨计算肾脏深度（KD）的分析方法是临床实践中确定肾脏肾小球滤过率（GFR）的唯一方法，该方法认为KD对GFR的影响比其他因素更重要。通过计算机断层扫描（CT）测量供体的KD可以提高盖茨方法测量GFR的准确性，但也会增加肾移植供体的辐射暴露。因此，建立一个更符合真实KD的准确KD测量经验公式尤为重要。
本研究共纳入326名潜在肾移植供体。其中，167名供体被分配到训练集，以估计CT测量的KD的回归公式。其余159名供体被纳入验证集，以验证回归公式。以CT测量的KD及其相应的GFR作为参考标准。然后比较各公式的性能。
CT测量的KD与当前拟合公式、李Q公式和薛JJ公式之间无显著统计学差异（P>0.05）。然而，使用泰勒公式、马G公式和内山公式计算的KD与CT测量的参考标准KD之间存在显著差异（P<0.05）。此外，拟合公式、马G公式和薛JJ公式对应的GFR与CT测量的KD对应的GFR之间无显著差异（P>0.05）。李Q公式对应的GFR也有显著差异（P<0.05），其他估计方法与CT测量的GFR之间也有显著差异（P<0.05）。
如果能找到一种准确测量体表肾门水平体厚的方法，本研究建立的拟合公式将发挥更重要的作用。
