Nankivell B J, Chapman J R, Allen R D
National Pancreas Transplant Unit, Westmead Hospital, Sydney, Australia.
Clin Transplant. 1995 Apr;9(2):129-34.
Impairment of glomerular filtration rate (GFR) after simultaneous pancreas and kidney (SPK) transplantation is an important marker of chronic renal rejection and recurrence of diabetic glomerulopathy. The use of unmodified serum creatinine to estimate GFR, however, is limited by variations in muscle mass. In this study, predictive factors for long-term GFR were evaluated in consecutive SPK recipients (n = 33) using a Tc99m DTPA GFR reference method between 90 days and 6 years after transplantation (n = 136 measurements). Substantial variability between serum creatinine and isotopic GFR after SPK (R2 = 0.30) high-lighted the inaccuracy of an unmodified serum creatinine in the evaluation of GFR. Factors which predicted GFR apart from serum creatinine included age, sex, height and body weight. A detailed formula was derived for accurate estimation of GFR (ml/min) = [71.4 (male) or 50.4 (female)] + 5520/creatinine (mumol/l) + 0.27 x body weight (kg) - 0.50 x age (yr) - 0.29 x height (cm). This formula was more accurate in estimation of GFR in SPK recipients than six published predictive methods which were derived from chronic renal failure patients using creatinine clearance. All of these methods overestimated GFR at lower levels of renal function. Most correlated poorly with Tc99m DTPA GFR and contained a generalized systematic overestimation of GFR which ranged from 4.7 to 8.4 ml/min (p < 0.05). A simplified version for rapid calculation was also derived as GFR (ml/min) = [25 (male) or 5 (female)] + 5000/creatinine (mumol/l).(ABSTRACT TRUNCATED AT 250 WORDS)
胰肾联合移植（SPK）后肾小球滤过率（GFR）受损是慢性肾移植排斥反应和糖尿病性肾小球病变复发的重要标志。然而，使用未修正的血清肌酐来估算GFR受到肌肉量变化的限制。在本研究中，采用Tc99m二乙三胺五乙酸（DTPA）GFR参考方法，对连续的SPK受者（n = 33）在移植后90天至6年期间（共136次测量）的长期GFR预测因素进行了评估。SPK后血清肌酐与同位素GFR之间存在显著差异（R2 = 0.30），这凸显了未修正的血清肌酐在评估GFR时的不准确。除血清肌酐外，预测GFR的因素还包括年龄、性别、身高和体重。由此得出了一个详细的公式用于准确估算GFR：GFR（ml/分钟）= [71.4（男性）或50.4（女性）] + 5520/肌酐（μmol/升）+ 0.27×体重（千克） - 0.50×年龄（岁） - 0.29×身高（厘米）。该公式在估算SPK受者的GFR方面比六种已发表的基于慢性肾衰竭患者肌酐清除率得出的预测方法更为准确。所有这些方法在肾功能较低水平时均高估了GFR。大多数方法与Tc99m DTPA GFR的相关性较差，并且对GFR存在普遍的系统性高估，高估范围为4.7至8.4 ml/分钟（p < 0.05）。还得出了一个简化版本用于快速计算：GFR（ml/分钟）= [25（男性）或5（女性）] + 5000/肌酐（μmol/升）。（摘要截于250字）
