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在患有慢性心力衰竭和缩功能障碍的患者中估计功能公式的缺点和预后价值
Tom D J Smilde1, Dirk J van Veldhuisen, Gerjan Navis
1Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands.
Circulation
|October 4, 2006
概括
使用肌素公式估计慢性心力衰竭 (CHF) 中的功能是常见的. 对于严重的CHF,MDRD和24小时肌素清除率提供准确的球过率 (GFR) 估计和良好的预后价值.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心脏病学 心脏病学
- 临床化学 临床化学
背景情况:
- 功能是慢性心力衰竭 (CHF) 患病率和死亡率的关键预测因素.
- 基于肌素的公式被广泛用于估计质过率 (GFR),但缺乏在多样化的CHF群体中验证.
- 准确的GFR估计对于管理CHF患者至关重要.
研究的目的:
- 验证三种常见的基于肌素的公式,用于估计CHF患者的GFR与真实GFR的GFR.
- 为了比较这些公式的预后值和12个月内心血管结果的真实GFR.
主要方法:
- 110名CHF患者接受了125I-IOTHALAMATE清除量的测量,以确定真正的GFR.
- 基于肌素的估计包括柯克克罗夫特-高尔特 (GFR) (cg),脏疾病饮食修改 (MDRD) 和简化MDRD (sMDRD).
- 还确定了24小时肌素清除率 (CrCl),并与真实GFR和基于配方的估计值进行了比较.
主要成果:
- CrCl和GFR (cg) 显示了最高的准确性,而MDRD是最精确的,尽管存在显著的偏差.
- 所有公式都显示了较低GFR范围的高估值和较高范围的低估值.
- 预测性表现在严重的慢性心血管功能障碍 (NYHA III-IV类) 中最好.
- 对心血管结果的预后值与真实GFR的CrCl和MDRD相似;sMDRD略低一些,GFR (cg) 明显更差.
结论:
- 在严重的CHF中,基于肌素的公式和CrCl (身体表面积纠正) 对于估计真实GFR更为精确和准确.
- 该MDRD公式提供了最好的精度和良好的预后价值.
- 虽然sMDRD公式略微不准确,但由于其简单性,它是一个实用的替代方案.
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