血清肌酐、身高和体重不能预测1型糖尿病儿童的肾小球滤过率。

Serum creatinine, height, and weight do not predict glomerular filtration rate in children with IDDM.

作者信息

Waz W R, Quattrin T, Feld L G

机构信息

Department of Pediatrics, Children's Hospital of Buffalo, NY 14222.

出版信息

Diabetes Care. 1993 Aug;16(8):1067-70. doi: 10.2337/diacare.16.8.1067.

DOI:10.2337/diacare.16.8.1067

PMID:8375234

Abstract

OBJECTIVE

To assess the validity of two equations: K x height/serum creatinine (KL/Cr; K = 0.55 for females 1-18 yr of age and 0.7 for males 12-18 yr of age) and (140 - age) x weight/72 x creatinine (x0.85 for women; Cockroft-Gault) in estimating glomerular filtration rate in children and adolescents with IDDM.

RESEARCH DESIGN AND METHODS

From the records of the Children's Hospital Diabetes Clinic, we selected 70 patients with GFR determined by 99mTc-labeled DTPA plasma clearance, stable renal function, and simultaneous measurements of height, weight, blood pressure, HbA1c, and plasma creatinine. We compared DTPA-GFR with estimated GFR from KL/Cr and Cockroft-Gault equations for three groups: all patients, patients with DTPA-GFR < or = 140 ml.min-1 x 1.73 m-2, and patients with DTPA-GFR > 140 ml.min-1 x 1.73 m-2.

RESULTS

For all patients, mean values for DTPA-GFR = 147 (95% confidence interval, 139-155), for KL/Cr = 118 (110-125), and for Cockroft-Gault = 84 ml.min-1 x 1.73 m-2 (78-90). For patients with DTPA-GFR < or = 140, DTPA-GFR = 123 (117-128), KL/Cr = 110 (100-119), and Cockroft-Gault = 92 (82-102). For patients with DTPA-GFR > 140, DTPA-GFR = 167 (158-177), KL/Cr = 125 (114-136), and Cockroft-Gault = 77 (71-84). Linear regression analysis showed significant (P < 0.05) relationships for KL/Cr only in patients with DTPA-GFR < or = 140 (r = 0.29), for Cockroft-Gault in all patients (r = -0.46), and for patients with DTPA-GFR < or = 140 (r = -0.31). Determination of a revised K for use in KL/Cr from individual calculations of K (DTPA-GFR x Cr/L) yielded an average value of 0.70 (SD = 0.11). With the use of K = 0.7, the mean KL/Cr value for patients with DTPA-GFR < or = 140 ml.min-1 x 1.73 m-2 was 125 +/- 27 (95% confidence interval, 115-135), compared with a DTPA-GFR value of 123 +/- 14 (95% confidence interval, 117-128).

CONCLUSIONS

KL/Cr and Cockroft-Gault do not accurately estimate DTPA plasma clearance. We recommend the use of K equal to 0.70 when estimating GFR in children and adolescents with IDDM and DTPA-GFR < or = 140 using KL/Cr and do not recommend the use of the KL/Cr (for patients with DTPA-GFR > 140) or the Cockroft-Gault equation in this population.

摘要

目的

评估两个公式的有效性：K×身高/血清肌酐（KL/Cr；1 - 18岁女性K = 0.55，12 - 18岁男性K = 0.7）以及（140 - 年龄）×体重/72×肌酐（女性×0.85；Cockcroft - Gault公式），用于估算1型糖尿病儿童和青少年的肾小球滤过率。

研究设计与方法

从儿童医院糖尿病诊所的记录中，我们选取了70例通过99mTc标记的二乙三胺五乙酸（DTPA）血浆清除率测定肾小球滤过率（GFR）、肾功能稳定且同时测量了身高、体重、血压、糖化血红蛋白（HbA1c）和血浆肌酐的患者。我们将DTPA - GFR与根据KL/Cr公式和Cockcroft - Gault公式估算的GFR进行比较，分为三组：所有患者、DTPA - GFR≤140 ml·min-1×1.73 m-2的患者以及DTPA - GFR＞140 ml·min-1×1.73 m-2的患者。

结果

对于所有患者，DTPA - GFR的平均值 = 147（95%置信区间，139 - 155），KL/Cr为118（110 - 125），Cockcroft - Gault为84 ml·min-1×1.73 m-2（78 - 90）。对于DTPA - GFR≤140的患者，DTPA - GFR = 123（117 - 128），KL/Cr = 110（100 - 119），Cockcroft - Gault = 92（82 - 102）。对于DTPA - GFR＞140的患者，DTPA - GFR = 167（158 - 177），KL/Cr = 125（114 - 136），Cockcroft - Gault = 77（71 - 84）。线性回归分析显示，仅在DTPA - GFR≤140的患者中，KL/Cr有显著（P＜0.05）相关性（r = 0.29）；在所有患者中，Cockcroft - Gault有相关性（r = -0.46）；在DTPA - GFR≤140的患者中也有相关性（r = -0.31）。通过对K（DTPA - GFR×Cr/L）进行个体计算来确定用于KL/Cr的修正K值，其平均值为0.70（标准差 = 0.11）。使用K = 0.7时，DTPA - GFR≤140 ml·min-1×1.73 m-2患者的平均KL/Cr值为125±27（95%置信区间，115 - 135），而DTPA - GFR值为123±14（95%置信区间，117 - 128）。

结论

KL/Cr和Cockcroft - Gault公式不能准确估算DTPA血浆清除率。我们建议在使用KL/Cr公式估算1型糖尿病且DTPA - GFR≤140的儿童和青少年的GFR时，使用K等于0.70，并且不建议在该人群中使用KL/Cr公式（对于DTPA - GFR＞140的患者）或Cockcroft - Gault公式。