慢性肾脏病早期筛查的临床应用评价  

Clinical application of early screening for chronic kidney disease

作　　者：黄玉霞[1] 杨渝伟[2] 唐敏[1] 刘小莉[1] 桑阳 徐艺筝 郭莉[1] 俸家富[2] HUANG Yuxia;YANG Yuwei;TANG Min;LIU Xiaoli;SANG Yang;XU Yizheng;GUO Li;FENG Jiafu(Laboratory Medicine,Sichuan Orthopedic Hospital,Chengdu,Sichuan 610041,P.R.China;Laboratory Medicine,Mianyang Central Hospital,Mianyang,Sichuan 621000,P.R.China)

机构地区：[1]四川省骨科医院检验科,成都610041 [2]绵阳市中心医院检验科,四川绵阳621000

出　　处：《华西医学》2018年第12期1507-1512,共6页West China Medical Journal

基　　金：四川省卫生和计划生育委员会科研课题(150175)

摘　　要：目的分析常用肾功能指标在不同年龄段受试者中对慢性肾脏病(chronic kidney disease,CKD)的筛查性能,探索中国人群CKD筛查方案。方法 2016年5月—2017年10月,将于四川省骨科医院或绵阳市中心医院就诊的成人受试者2 131例按年龄段分成3组:18～39岁(A组,n=278)、40～64岁(B组,n=1 167)、≥65岁(C组,n=686)。测定其血清肌酐(serum creatinine,SCr)、尿素和胱抑素C(cystatin C,CysC),计算估计肾小球滤过率(estimated glomerular filtration rate,eGFR),测定尿液白蛋白、总蛋白和肌酐,并计算得出尿白蛋白/肌酐比(albumin to creatinine ratio,ACR)和总蛋白/肌酐比(protein to creatinine ratio,PCR)。按改善全球肾脏病预后组织(Kidney Disease:Improving Global Outcomes,KDIGO)指南(2012年版)诊断CKD。然后用受试者工作特征(receiver operating characteristic,ROC)曲线分析各观察指标对CKD的诊断性能。结果 A组、B组和C组患者CKD的患病率分别为10.8%(30/278)、16.4%(191/1 167)和45.8%(314/686),差异有统计学意义(χ2=233.525,P<0.001)。各年龄组中,6个肾功能指标水平在CKD和非CKD受试者间的差异均有统计学意义(P<0.05)。经ROC曲线分析,除在A组eGFR、CysC、尿素和SCr诊断性能相当外,各指标对CKD的诊断性能:ACR或PCR>eGFR或CysC>尿素或SCr(P<0.05)。3个KDIGO推荐指标中,ACR和PCR在各年龄段组的诊断性能:B组(0.915、0.914)>A组(0.885、0.890)>C组(0.841、0.846);而eGFR在各年龄段组的诊断性能:C组(0.807)>B组(0.728)>A组(0.696)。其最佳判断界值,ACR和PCR低于而eGFR高于KDIGO推荐的医学决定水平。结论肾功能指标肌酐正常情况下,ACR是筛查CKD的首选指标,eGFR可进一步提高诊断率,尤其是65岁以上受试者。Objective To evaluate the screening performance of commonly used renal function indicators for chronic kidney disease(CKD) in subjects of different ages, so as to explore the appropriate screening regimen for Chinese population. Methods A total of 2 131 adult subjects in Sichuan Orthopaedic Hospital or Mianyang Central Hospital from May 2016 to October 2017 were selected. They were divided into three groups according to age: group A(18–39 years, n=278), group B(40–64 years, n=1 167), and group C(≥65 years, n=686). Serum levels of creatinine(SCr), urea,and cystatin C [CysC; to calculate estimated glomerular filtration rate(eGFR) based on this index], as well as urine levels of albumin, total protein and creatinine were measured, and urine albumin to creatinine ratio(ACR) and urine protein to creatinine ratio(PCR) were calculated respectively. CKD was diagnosed according to the Kidney Disease: Improving Global Outcomes(KDIGO) Guideline(2012 Edition). The receiver-operating characteristic(ROC) curve analysis was finally performed to investigate the diagnostic performance of each indicator for CKD. Results The prevalences of CKD in group A, B, and C were 10.8%(30/278), 16.4%(191/1 167), and 45.8%(314/686), respectively, and the difference among these groups was statistically significant(χ2=233.525, P<0.001). In addition, the levels of the six renal function indicators between CKD and non-CKD subjects also had statistically significant differences in different age groups(P<0.05).Otherwise, ROC curve analysis revealed that the diagnostic values of these indicators were: ACR or PCR > eGFR or CysC> serum urea or SCr(All P<0.05), except that eGFR, CysC, serum urea and SCr in group A assessed the similar diagnostic performance. Among the three indicators recommended by KDIGO Guideline, the diagnostic performances of ACR and PCR in different age groups were: group B(0.915, 0.914) > group A(0.885, 0.890) > group C(0.841, 0.846), while the diagnostic performance of eGFR was group C(0.807) > group B(0.728) > group A(0.6

关 键 词：慢性肾病 尿白蛋白肌酐比 尿总蛋白肌酐比 估计肾小球滤过率 胱抑素C 

分 类 号：R692[医药卫生—泌尿科学]