Optimization Of GFR Estimation Formula For Diabetic Nephropathy And Establishment Of Estimation Formula Based On TCM Syndrome

Objective:We use the measured glomerular filtration rate (GFR) by yhe renal dynamic imaging as the gold standard, to evaluate the applicability in Chinese diabetic nephropathy (DN) patients. We choose the optimal formula which has the the best coherence with the golden standard and optimize the old coefficients. Relying on the data of the "eleventh five" National Science and Technology Support Program, we try to explore the correlation between TCM syndrome integral and eGFR by using the optimal formular.Try to estimate the eGFR formula which based on TCM syndrome integral. By using the K nearest neighbor method (KNN method), try to establish the database, which can be used to evaluate GFR based on TCM syndrome integral. By verifying the new method and the new formula, we try to explore the correlation between TCM syndrome integral and GFR, and to find the suitable formula for Chinese DN patients to evaluate their GFR.Methods:Study 1:Choose 107 cases of DN hospitalized patients who have taken the renal dynamic imabing and renal function test as the research object. Caculate the value of GFR by using CG formula, CKD-EPI formula, improved simplified MDRD formula (Chinese formula) and Ruijin formula. Take the measured GFR as the gold standard. Evaluate the consistency between the gold standard and the established ones by using correlation analysis, variance analysis, Bland-Altman method and ICC evaluation. Evaluate the diagnostic efficacy by using ROC curve. Optimize the coefficient by using templates which come from CG formula, CKD-EPI formula and MDRD formula. And then, evaluate the new formula.Study 2:Rearrange the "eleventh five" research data according to the visit times. Eliminate the incomplete cases on TCM syndrome integral, sex, age, height, weight, and creatinine. Investigate the relationship between TCM syndrome integral and laboratory indexes on the whole and in different CKD stages.Study 3:Recaculate the value of GFR on 1872 caes in the "eleventh five" stady by using Chinese formula and MDRD# formula which is the best one in study 1. According to the recalculated value, establish the new GFR formula based on TCM syndrome integral by using multivariate linear regression. Order the 1872 cases according to the random number and visit times. According to the ratio of 3:1, divide the cases into 2 groups. Group 1 has 1400 cases and group 2 has 472 cases. Establish the new formular by multiple linear regression and the database by KNN method based on group 1. Verify and evaluate the effect based on group 2.Results:Study 1:Chinese formula has the minimum mean deviation compared with the glod standard. But it has the largest deviation of the standard deviation. Chinese formula and Rui jin formula underestimate the real value when GFR is in low level. With the increase of GFR, underestimation changes into over estimation, and the degree grows larger. The coincidence rate of 30% of CG formula and CKD-EPI formula are better than Chinese and RUijin formula. But the CG formula underestimates the value of GFR, and the CKD-EPI formula overestimates the value of GFR. The 30% coincidence rate of CG formula is only 55.1% which is the best of the 4 ones. The Bland-Altman map shows that CG formula and CKD-EPI formula have more data which is Included in the confidence interval. ROC curve analysis shows that, when the diagnostic criteria is settled as GFR< 60 ml/(min·1.73m2), CKD-EPI foemular has the best sensitivity and Chinese formula has the best specificity. Comprehensive evaluating of area under the curve and Youden index, CG formula and CKD-EPI formula are better than Chinese formular and Ruijin formular. When the diagnosis of node comes to 90 ml/(min·1.73m2), the diagnostic efficacy of 4 formulas is CKD-EPI formula> CG formula> Chinese formula> Rui jin formula.4 formulas have different applicabilities in different period of CKD staging. Optimal formulas are better than original ones in consistency with the gold standard and the diagnosis effect.MDRD# is the best optimal formula of the 3 ones. MDRD# formula:eGFR=1720 × Scr-0.602 × age-0.785 × 0.818 (female).Study 2:1872 cases bave been included in the study. The correlation between the TCM syndrome integrals and laboratory indexes are significant, especially with Yang deficiency, blood deficiency, phlegm and dampness. EGFR is negatively correlated with the TCM syndrome integral in both total and every syndrome (P< 0.05).Study 3:Take Chinese formula and MDRD# formula as gold standard respectively, we obtained 8 formulas (or data sets) by using 4 kinds of methods. The coincidence rate of 30% of regression equation 1 is 58.6%. The coincidence rate of 30% of regression equation 2 reachs 85.8%. Regression equation 3 and 4 has differences in gender. Their coincidence rate do slightly better than 1 and 2. Regression equation 5 and 6 are base on the data of group 1, which seems like regression equation 1 and 2. Regression equation 6 is clearly better than 5. The area under the ROC curve reaches 0.807. The coincidence rate of 30% of KNN7 and KNN8 have reached 69.3% and 89.2%, both of which are obtained by KNN method. The coincidence rate of 15% of KNN8 even reached 69.5%.Conclusion:4 estimation formulas are not very ideal with Chinese DN patients when compared with the measured GFR value. In generally speaking, CG formula and CKD-EPI formula are more suitable. Ruijin formula is suitable for CKD staging of DN patients, which has the best correlation with the glod standard. CKD-EPI formula is suitable for CKD1 and CG formula is suitable for CKD2. Chinese formula is suitable for both CKD3 and CKD4. It is better to evaluate comprehensively by CG formula and Chinese formula when it comes to CKD5. Optimal formulas are better than original ones in consistency with the gold standard and the diagnosis effect.MDRD# is the best optimal formula of the 3 ones. The correlation between the TCM syndrome integrals and laboratory indexes are significant, especially with Yang deficiency, blood deficiency, phlegm and dampness. It is feasible to evaluate GFR by using TCM syndrome integral. KNN method is better than multiple linear regression method。It has been proved that he KNN database which is based on MDRD# formular has the best effect.