尿钙/肌酐比值不能替代24小时尿钙检测诊断高尿钙  

Spot urine calcium-to-creatinine ratios be not used to diagnose hypercalciuria replacing 24 hours urinary calcium

作　　者：刘峥[1] 张鹏睿[1] 潘永华[1] 王广[1] 宁志伟[1] 

机构地区：[1]首都医科大学附属北京朝阳医院内分泌科,北京100020

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2015年第3期219-223,共5页Chinese Journal Of Osteoporosis And Bone Mineral Research

摘　　要：目的评估即刻尿钙与尿肌酐比值（ratio of urine calcium to creatinine,UCa/Cr）与24小时尿钙（24 hours urine calcium,24 h UC）的相关性,寻找以UCa/Cr代替24 h UC诊断高尿钙的最佳诊断切点,并判断两种方法的一致性。方法选择本科住院患者160例,留取24 h UCa/Cr、即刻尿标本,分别检测24 h UC、即刻尿钙、尿肌酐,计算UCa/Cr,做受试者工作特征（receiver operating characteristic,ROC）曲线,寻找最佳诊断切点,并计算其敏感度、特异度、误诊率。采用Bland-Altman绘图和数据分析,比较UCa/Cr与24 h UC一致性。结果 UCa/Cr与24 h UC呈显著正相关（r=0.510,95%置信区间0.38~0.62,P=0.000）。以24 h UC为金标准,UCa/Cr的最佳诊断切点为0.162,其敏感度为61.5%~72.7%,特异度为67.8%~75.5%,误诊率达54.7%~73.1%。应用UCa/Cr结果预测24 h UC,UCa/Cr平均低估24 h UC 66.2 mg,95%一致性界限为-324.5~192.0 mg。结论由于误诊率高,一致性差,即刻UCa/Cr比值不能代替24 h UC作为高尿钙诊断指标。Objective To determine extent of correlation of spot ratio of urine calcium to reatinine（ UCa/Cr） with24 hours urine calcium（ 24 h UC） and to find the cut point of UCa / Cr for diagnosis. We also evaluated the accordance of UCa / Cr and 24 h UC measurements. Methods We collected the 24-hour urine samples and the spot urine samples,detected 24 h UC, urinary calcium and creatinine,then calculated UCa / Cr. The receiver operating characteristic（ ROC） curve was drawn to find the cut point of UCa/Cr for diagnosis of hypercalciuria. We evaluated the sensitivity,specificity and the misdiagnosis rate and consistency of UCa / Cr with the 24 h UC with Bland-Altman analysis. Results UCa / Cr were positively correlated with 24 h UC significantly（ r = 0. 510,95% confidence interval： 0. 38- 0. 62,P =0. 000）. When we made the 24 h UC the golden standard,the cut point of UCa / Cr was 0. 162,with the sensitivity and specificity of 61. 5%- 72. 7% and 67. 8%- 75. 5%, respectively. The misdiagnosis rate were as high as from54. 7% to 73. 1%. UCa / Cr was average 66. 2 mg lower than 24 h UC with 95% confidence interval of- 324. 5 to 192.Conclusion UCa / Cr measurements, although has a reasonable correlation, but poor consistency with the 24 h UC measurements. Clinicians should still use the 24 h UC to diagnose hypercalciuria compared to spot UCa / Cr ratio.

关 键 词：尿钙与尿肌酐比值 高尿钙 骨质疏松 肾结石 

分 类 号：R681[医药卫生—骨科学]