Establishment And Clinical Application Of Digital Measurement System For Progression Speed Of Patients With Chronic Renal Failure

PurposeReferring to Mitch's method of measuring the progression speed of renal function in patients with chronic renal failure(CRF)and according to scientific and reasonable experimental methods,a digital system can be established to measure the progression speed of patients with CRF,and applied clinically to evaluate the renal function progress of CRF patients.The aim is to provide a theoretical basis for that prognosis of CRF patient,delay the progression of renal function and prolong the survival time of CRF patients.Method1.Establish a computer digital detection system for the progression speed of patients with CRF(1)Retrieving Chinese and foreign databases: Wanfang Data,CNKI,VPCS,VIP,SinoMed,Baidu Scholar,FMRS,Google Scholar,WileyOline Library,American Medical Association,Embase,Medline,Pubmed,Web of Science,Medline,Springerlink and other databases.Referring to the method of foreign scholar Mitch to measure the progression speed of CRF patients,a large number of documents were searched,and then reliable indicators that can be used for measurement were selected.(2)The establishment of this system includes the inclusion of serum creatinine,serum cystatin C and ?2 microglobulin.The system can be implemented through: Progression Rate Measurement System for CRF Patients Calculating 1/SCr and Time Curve Slope,Progression Rate Measurement System for CRF Patients Calculating 1/SCys C and Time Curve Slope,Progression Rate Curve Measurement System for CRF Patients Calculating 1/S?2-MG and Time Curve Slope,as well as the Progression Rate Measurement System for CRF Patients,and Progression Rate Measurement System for CRF Patients Calculating eGFR and Time Curve Slope.Among them,the Progression Rate Measurement System for CRF Patients Calculating eGFR and Time Curve Slope is adapted from the computer digital analysis system for joint measurement of glomerular function in previous years,and its accuracy has been verified through experiments.The beautiful and high-definition landscape pictures are selected,and the color is mixed with the picture editing software.After processing,the database is established as the system background.After repeatedmodification and adjustment,the created detection system is encrypted,packaged and installed on the computer.2.Clinical application research(1)Case data: A total of 42 patients from our hospital were collected in this study,including 26 males(61.9%)and 16 females(38.1%).The baseline age of all patients was 33-83 years old,with an average age of(60.31±12.78)years old.The baseline renal function was CKD2 in 7patients,CKD3 in 18 patients and CKD4 in 17 patients.The causes were primary glomerulonephritis in 21 patients(50.0%),diabetic nephropathy in 8 patients(19.0%)and hypertensive renal arteriosclerosis in 13 patients(31.0%).(2)Grouping:Control group: Up to now,the plasma clearance rate measured by exogenous markers is the gold standard for evaluating renal function at home and abroad,while 99mTc-DTPA is used as exogenous marker,and99mTc-DTPA renal dynamic imaging method is widely used.With the passage of time,the change of GFR to time is the progression speed of CRF patients,so the progression speed of renal function of CRF patients measured by the slope of MGFR to time curve is taken as the control group.For a small number of patients lacking mGFR results,the progress rate measured by eGFR measurement system is used instead.Observation group:(1)Progression Rate Measurement System forCRF Patients Calculating 1/SCr and Time Curve Slope;(2)Progression Rate Measurement System for CRF Patients Calculating 1/SCysC and Time Curve Slope;(3)Progression Rate Curve Measurement System for CRF Patients Calculating 1/S2-MG and Time Curve Slope;(4)A system for measure that progression rate of patients with CRF;The results of the above four systems were taken as the observation group.(3)Clinical comparative study:One-way ANOVA was used to compare the difference of slope mean measured by each system.Spearman correlation analysis was used to compare the advantages and disadvantages of each system in the observation group with that in the control group.(4)Diagnostic efficiency analysis of each system:Based on whether there are acute aggravating factors judged clinically,the diagnostic efficiency of each subsystem is evaluated through ROC curve,area under analysis curve,Youden index,sensitivity,specificity,etc.Results1.The characteristics of the computer digital measurement system for the progression speed of CRF patients(1)The CRF patient progression speed measurement system is a system developed after verifying the measurement method of foreign scholar Mitch and consulting a large number of literatures to find theXindex that can be used to measure the renal function progression speed of CRF patients,i.e.The index that is linearly related to GFR and serum creatinine.Through reasonable and scientific programming,continuous debugging and modification,the system can be developed,the system can be implemented through: Progression Rate Measurement System for CRF Patients Calculating 1/SCr and Time Curve Slope,Progression Rate Measurement System for CRF Patients Calculating 1/SCys C and Time Curve Slope,Progression Rate Curve Measurement System for CRF Patients Calculating 1/S?2-MG and Time Curve Slope,as well as the Progression Rate Measurement System for CRF Patients,and Progression Rate Measurement System for CRF Patients Calculating eGFR and Time Curve Slope.(2)The system has beautiful interface,simple operation,and humanized functions such as one-key emptying and error reminding.The generated reports can be saved and printed,and the following instructions are attached to each generated report to provide reference for clinicians to evaluate the disease progression of patients and treat diseases.(3)This measurement system is the first of its kind at home and abroad.Except for serum creatinine,there are few reports on other indicators that use the same method to measure the progress rate of renal function at home and abroad.2.Clinical comparative study of the established systemThe difference between the calculation results of each group was0.00,P < 0.05,and the difference was statistically significant.This study believes that when the slope is used to represent the progression speed of renal function in CRF patients,the same slope measured by different indicators cannot represent the same progression speed.The progression speed measured by each system in the observation group was significantly positively correlated with the progression speed measured by mGFR(P < 0.05).Among them,the correlation between the test results of the comprehensive test system and the test results of the control group is the best(r=0.893,P < 0.05).The other systems are significantly positively correlated with the progression speed measured by mGFR,which can be considered to reflect the progression speed of patients with CRF to a certain extent.When ROC curve is used to analyze the diagnostic efficiency of the system in judging whether there are aggravating factors in patients,the clinical actual judgment results are taken as the standard.The comprehensive judgment system has the largest area under the curve(AUC=0.842),the highest Youden index is the comprehensive judgment system,which is 0.702,the best truncation value is 0.00170,the sensitivity is 87.9%,and the specificity is 82.3%.However,the sensitivity and specificity of the other systems are more than 70%.The system for comprehensive analysis and comprehensive measurement of the progression speed of CRF patients has the highestdiagnostic efficiency,while the other subsystems have certain diagnostic efficiency.Therefore,the system can be used clinically to provide theoretical basis for evaluating the progress of CRF patients,judging whether there are aggravating factors and adjusting treatment.ConclusionThe digital detection system for CRF patients' development speed has undergone reasonable experiments and has been debugged and corrected many times.The operation is easy and can be comprehensively calculated by multiple indicators.What's more,each subsystem contained in it has high accuracy and diagnostic efficiency.It has important clinical application value in measuring the development speed of renal function in CRF patients,judging whether there are aggravating factors,adjusting treatment,suggesting prognosis of CRF patients and prolonging survival time of patients.