探讨晨尿蛋白/肌酐比值的诊断界值及临床应用  

Survey on diagnosis critical value of protein-creatinine ratio in morning urine and clinical application

作　　者：孙宏勋[1] 谢永富[1] 周东升[2] 

机构地区：[1]河北医科大学第三医院检验科,河北石家庄050051 [2]中国电子科技集团公司第54研究所医院,河北石家庄050081

出　　处：《临床荟萃》2009年第21期1877-1880,共4页Clinical Focus

摘　　要：目的通过调查健康人群和肾病患者晨尿蛋白/肌酐比值,以及肾病患者24小时尿蛋白定量,界定晨尿蛋白/肌酐比值的正常、病理诊断临界值。方法选取临床确诊的住院及门诊肾脏病患者129例,留取其晨尿、24小时尿两份标本,同时进行尿蛋白,尿肌酐的测定,计算晨尿蛋白/肌酐比值,将比值与24小时尿蛋白结果进行相关性分析;同时用受试者工作曲线(receiver operating characteristics,ROC)曲线探讨肾病患者相对于24小时尿蛋白定量,轻度蛋白尿<1.0 g/d,重度蛋白尿>3.0 g/d时,晨尿蛋白/尿肌酐相对应的最佳诊断界点。留取门诊健康人群尿常规检查及镜检结果全阴性,询问无现病史的晨尿标本211人份,测定晨尿蛋白/肌酐比值,相对于129例肾病患者的晨尿蛋白/肌酐比值,用ROC曲线探讨晨尿蛋白/肌酐比值的病理最佳诊断界点。结果晨尿蛋白/肌酐比值与24小时尿蛋白呈显著正相关(r=0.892,P<0.01);24小时尿蛋白定量轻度蛋白尿<1.0 g/d,重度蛋白尿>3.0 g/d,晨尿蛋白/尿肌酐(UCr)相对应的最佳诊断界点为<0.90 g/g(敏感度96.2%,特异度86.2%)、>2.88 g/g(敏感度82.9%,特异度85.6%);无现病史的晨尿标本尿蛋白/尿肌酐比值,相对于肾病患者的晨尿蛋白/肌酐比值,ROC曲线最佳诊断界点为0.23 g/g(敏感度82.9%,特异度86.0%)。结论晨尿蛋白/肌酐比值诊断界点可替代24小时尿蛋白定量的检测。Objective By survey on the protein/creatinine ratio in morning urine in healthy people and patients with kidney diseases and by measuring 24 hour urine protein,the authors deduced the critical value of morning urinary protein/creatinine ratio of normal and pathological diagnosis. Methods There were 129 in- and out-patients with kidney diseases and 211 healthy people in the study. Their first morning and 24 hour urine specimens were collected; urine protein and urine creatinine were examined;morning urinary protein/creatinine ratio was calculated;the correlation was analyzed between morning urinary protein/creatinine ratio and 24 hour urine protein. Using ROC curve, the critical values of morning urinary protein/creatinine ratio of normal and pathological diagnosis in kidney diseases were explored. Results There was a marked positive relation between morning urinary protein/creatinine ratio and 24 hour urine protein（ r = 0. 892, P 〈 0.01）;the critical value was 〈 0.90 g/g and 〉 2.88 g/g with the urine protein concentration of 〈1.0 g/d （the sensitivity was 96.2%;the specificity was 86.2%） and 〉 3.0 g/d （the sensitivity 82.9 % ;the specificity 85.6 % ）, respectively; the healthy people had a critical value of 0.23 g/g （the sensitivity 82.9 % ; the specificity 86.0%）. Conclusion The critical value of morning urinary protein/creatinine ratio can replace 24 hour urine protein in diagnosis of kidney diseases.

关 键 词：肾疾病 尿分析 蛋白尿 

分 类 号：R692[医药卫生—泌尿科学]