Accurate Estimation of Creatinine Clearance Based on Lean Body Mass Measured by Bioelectrical Impedance Analysis in Non-Small Cell Lung Cancer

藉由生物電子阻抗測定的脂肪除外體重來估算非小細胞肺癌病人的肌酸酐廓清率

徐國軒(Kuo-Hsuan Hsu) ； 楊宗穎(Tsung-Ying Yang) ； 張基晟(Gee-Chen Chang) ； 許正園(Jeng-Yuan Hsu)

《胸腔醫學》 22卷1期 (2007/02) Pp. 13-20

https://doi.org/10.29806/TM.200702.0002

摘要

在晚期的非小細胞肺癌的病人，治療皆是全身性的化學治療為主，現今主要是以白金類(Platinum)的化學藥物為基礎，搭配一個新的第三代的化學藥物為輔。不過因白金類的化學藥物如順鉑(Cisplatin)有腎毒性，所以在作化學治療時，會根據病人腎臟功能作劑量的調整，在以前，都會留24小時的尿液來計算病人的24小時肌酸酐廓清率，不過，這樣的作法會浪費許多的時問，後來慢慢就使用Cockcroft-Gault方程式，估算病人的24小時肌酸酐廓清率，來代表病人的腎臟功能。不過，在之前的研究發現，這樣估算的24小時肌酸酐廓清率，常會有的低估的情形。另外，之前的研究也顯示，尿液肌酸酐的排除和脂肪除外體重有相當的關係。所以我們設計這個實驗，藉由生物電子阻抗測定的方法，來測量病人的脂肪除外體重，結果發現，脂肪除外體重和病人尿液肌酸酐的排除有正相關性，並且藉由脂肪除外體重，我們也可以比較精確的來估算病人24小時肌酸酐廓清率。

關鍵字

肌酸酐廓清率 ； 脂肪除外體重 ； 非小細胞肺癌

並列摘要

Background: The Cockcroft-Gault (C-G) formula has been widely used to substitute for 24-hour creatinine clearance (24-hour Ccr) in estimating the glomerular filtration rate, but in our previous study, it underestimated the 24-hour Ccr markedly in advanced-stage non-small lung cancer (NSCLC) patients. It has been reported that there is a very high correlation between urinary creatinine excretion (Ucr) and lean body mass (LBM). The purpose of this study was to evaluate the feasibility of using LBM measured by bioelectrical impedance analysis (BIA) to estimate the 24-hour Ccr in advanced-stage NSCLC patients.
Methods: Eighty-four patients with advanced NSCLC, who were admitted for the first cycle of chemotherapy, participated in this study. Twenty-four-hour urine was collected and LBM was obtained by BIA before chemotherapy. We evaluated whether or not there was a significant correlation between 24-hour Ucr and LBM. If there was, LBM was used to estimate 24-hour Ucr, thus 24-hour Ccr. The creatinine clearance predicted from LBM measured by the BIA method (LBM Ccr) and C-G formula (C-G Ccr) was compared to the 24-hour Ccr.
Results: There was a significant correlation between LBM and 24-hour Ucr (r=0.798). The Ccr obtained by the C-G formula underestimated the 24-hour Ccr by a mean of 12.3 ml/min. The LBM Ccr was highly correlated with 24-hour Ccr (r=0.848), with a mean difference of 0.1 ml/min. The agreement of predicted Ccr, using LBM measured by the BIA method and the C-G formula with 24-hour Ccr, was similar.
Conclusion: The C-G formula underestimated the 24-hour Ccr significantly in patients with advanced-stage NSCLC. LBM measured by the BIA method was significantly correlated with 24-hour Ucr. It is feasible to predict 24-hour Ccr using LBM measured by the BIA method in these patients.

並列關鍵字

creatinine clearance ； lean body mass ； non-small cell lung cancer