肾小球滤过率的测定方法及其临床应用

doi:10.3969/j.issn.1673-8640.2015.07.003

摘要/Abstract

摘要：

肾小球滤过率(GFR)是衡量肾功能的最佳指标,在临床工作中具有重要的参考价值,其数值是否准确对诊疗决策的优化影响重大。GFR可以通过估算公式或直接测量获得,估算肾小球滤过率(eGFR)在特定情况或特殊人群中易出现偏倚,采用直接测量的GFR(mGFR)评价肾功能更为准确。结合菊粉、肌酐、碘海醇、^99m锝-二乙烯三胺五醋酸(^99mTc-DTPA)、⁵¹铬-乙二胺四乙酸、¹²⁵I-碘肽酸盐等常用肾小球滤过标志物的不同特性,可分别采用血、尿清除率或肾动态显像法测量mGFR,但所得结果的准确性不一。鉴于其它方法的耗时繁琐,临床应用多选择内生肌酐清除率(Ccr)对肾功能进行评估,但综合各项研究证实Ccr存在显著偏倚,易高估GFR。尿液碘海醇清除率、^99mTc-DTPA清除率的准确性较高,更适宜推广于临床。GFR测量方法作为各类eGFR公式的验证手段,在临床工作中的应用和评价不容忽视,值得进一步研究。

关键词: 肾小球滤过率, 内生肌酐清除率, 碘海醇, 放射性核素, 肾功能

Abstract:

As the best scaleplate for evaluation on kidney function, the glomerular filtration rate (GFR) plays an important role in daily practice and has a great influence on the optimization of diagnosis and treatment. GFR can be estimated through different formulas based on routine text results or measured directly. Bias may arise in certain situations as well as special populations when using estimated glomerular filtration rate (eGFR),while measured glomerular filtration rate (mGFR) is more reliable. Regarding the different properties of common filtration markers such as inulin,creatinine,iohexol, ^99mtechnetium-diethylene triamine pentaacetic acid (^99mTc-DTPA),⁵¹chromium-ethylene diamine tetraacetic acid and iothalamate, we could measure mGFR by means of blood and urine clearance rates or kidney dynamic imaging, and the results shows different accuracies. Endogenous creatinine clearance rate is widely used in common practice for convenience,while plenty of studies have revealed its remarkable bias of overestimating GFR. Regarding the outstanding performances in accuracy, either urine iohexol or ^99mTc-DTPA clearance rate is better for popularization. As the validation for eGFR, mGFR deserves further work on its application and evaluation.

Key words: Glomerular filtration rate, Endogenous creatinine clearance rate, Iohexol, Radionuclide, Kidney function

中图分类号:

R446.1

虞倩, 王蓓丽综述, 郭玮, 潘柏申审校. 肾小球滤过率的测定方法及其临床应用[J]. 检验医学, 2015, 30(7): 674-679.

YU Qian, WANG Beili, GUO Wei, PAN Baishen. The methods for measuring glomerular filtration rate and their clinical application[J]. Laboratory Medicine, 2015, 30(7): 674-679.

图/表 1

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标志物	优点	缺点
菊粉	理想标志物,无毒无害,无肾小管排泌和重吸收	血尿样品需特殊去蛋白处理,检测方法繁琐
肌酐	内源性标志物,无需额外摄入,检测方法满足标准化和一致性	个体生成速率差异较大,存在肾小管排泌和重吸收
碘海醇	廉价易得,无放射性,无肾小管分泌	在肾小管有少量重吸收,不良反应报道,碘过敏受检者慎用
^99mTc-DTPA	常用易得,半衰期短,辐射曝露较小,无肾小球排泌及重吸收	放射性药物需特殊制备及管理,^99mTc与DTPA的解离率影响检测结果
⁵¹Cr-EDTA	国内较少应用	存在肾小管重吸收及血浆蛋白结合
¹²⁵I-碘肽酸盐	无血浆蛋白结合	放射性药物,存在少量肾小管分泌及重吸收,碘过敏受检者慎用
Gd-DOTA	磁共振常规造影剂,较为易得	具有潜在肾脏毒性

标志物	优点	缺点
菊粉	理想标志物,无毒无害,无肾小管排泌和重吸收	血尿样品需特殊去蛋白处理,检测方法繁琐
肌酐	内源性标志物,无需额外摄入,检测方法满足标准化和一致性	个体生成速率差异较大,存在肾小管排泌和重吸收
碘海醇	廉价易得,无放射性,无肾小管分泌	在肾小管有少量重吸收,不良反应报道,碘过敏受检者慎用
^99mTc-DTPA	常用易得,半衰期短,辐射曝露较小,无肾小球排泌及重吸收	放射性药物需特殊制备及管理,^99mTc与DTPA的解离率影响检测结果
⁵¹Cr-EDTA	国内较少应用	存在肾小管重吸收及血浆蛋白结合
¹²⁵I-碘肽酸盐	无血浆蛋白结合	放射性药物,存在少量肾小管分泌及重吸收,碘过敏受检者慎用
Gd-DOTA	磁共振常规造影剂,较为易得	具有潜在肾脏毒性