摘要：目的：评价4种基于血清肌酐（Cr）或基于血清半胱氨酸蛋白酶抑制剂C（CysC）的估算肾小球滤过率公式在体检人群中的适用性。 方法：随机取出2 032例体检健康者，分别检测血清Cr、CysC、尿清蛋白和肌酐比值（ACR），通过4种公式，即同位素稀释质谱法 肾脏病膳食改善公式（IDMS-MDRD）、慢性肾脏病流行病合作组（CKD-EPI）公式（EPI-Cr、EPI-CysC和EPI-Cr-CysC），分别计算其估算的肾小球滤过率（eGFR）并进行比较。 结果：2 032例体检健康者血清Cr为（65.4±14.3）μmol/L，血清CysC为（0.77±0.19）mg/L，ACR中位数为3.1 mg/g。将4种公式计算的eGFR值按照<60 mL/min/1.73 m2、60~89 mL/min/1.73 m2、≥90 mL/min/1.73 m2分为3组，3组分布差异均有统计学意义（P<0.05）。联合4种公式计算的eGFR和ACR对CKD预后分为低危、中危、高危和极高危4期，各期分布差异无统计学意义（P均>0.05）。在2 032例健康人群中，以EPI-Cr公式计算的eGFR值在45~60 mL/min/1.73 m2之间的例数为44例（2.2%），以IDMS-MDRD公式计算的eGFR值在45~60 mL/min/1.73 m2之间的例数为58例（2.9%），该58例人群的ACR结果有45例<30 mg/g，以EPI-Cr-Cys公式计算该45例人群的eGFR值，有40例> 60 mL/min/1.73 m2。 结论：联合eGFR和ACR对CKD预后进行分期，4种公式的一致性高。对于选用基于血清Cr的IDMS-MDRD公式计算的eGFR值，如果在45~60 mL/min/1.73 m2之间，建议检测CysC，并且采用血清Cr和CysC联合公式计算eGFR，以减少对患者GFR的误判。
Abstract: Objective：To evaluate the application of four formulae for estimated glomerular filtration rate (eGFR) based on serum creatinine or cystatin C in health examination population. Methods：A total of 2 032 cases were selected randomly from health examination population to determined serum creatinine and cystatin C, urinary albumin to creatinine ratio (ACR). eGFR were calculated by 4 formulae, i.e., isotope dilution mass spectrometry modification of diet in renal disease (IDMS-MDRD) formula and chronic kidney disease epidemiology cooperation (CKD-EPI) formula: creatinine (EPI-Cr), cystatin C (EPI-Cys) and CKD-EPI creatinine-cystatin C combination formula (EPI-Cr-Cys), and the results were compared. Results：Of the 2 032 subjects, serum creatinine was (65.4±14.3) μmol/L, serum cystatin C was (0.77±0.19) mg/L, the median of urine ACR was 3.1 mg/g Cr. The eGFR valus were divided into 3 groups, <60 mL/min/1.73 m2, 60-89 mL/min/1.73 m2 and ≥90 mL/min/1.73 m2. The numbers of distribution in each group calculated by 4 eGFR formulae were significantly different (all P<0.05). The CKD prognosis by combination of GFR and ACR were divided into 4 stages: low risk, moderately increased risk, high risk and very high risk. The cases in each stage calculated by 4 eGFR formulae showed no significantly different (all P>0.05). Among the 2 032 cases, the number of eGFR calculated by EPI-Cr formula between 45 and 60 mL/min/1.73 m2 was 44 cases (2.2%), the number of eGFR calculated by IDMS-MDRD formula between 45 and 60 mL/min/1.73 m2 was 58 cases (2.9%) in whom 45 cases were <30 mg/gCr of ACR results. Among this 45 cases, the eGFR values of 40 cases calculated by EPI-Cr-Cys formulawere > 60 mL/min/1.73 m2. Conclusion：The estimated stages of CKD prognosis by combination of eGFR and ACR may significantly improve the consistency of the 4 eGFR formulae. For the eGFR values calculated by IDMS-MDRD formula between 45 and 60 mL/min/1.73 m2, CysC measurement should be recommanded, and EPI-Cr-Cys formula should be suggested to calculate eGFR in order to reduce misdiagnosis of CKD.