应用空腹1 h尿钙浓度能否诊断糖尿病患者高尿钙?  

Can urinary calcium concentration after 1 hour fasting be used to diagnose hypercalciuria in diabetes mellitus patients?

作　　者：刘峥 张鹏睿[2] 陈哲[2] 高霞[2] 

机构地区：[1]首都医科大学石景山教学医院北京市石景山医院门诊办公室,北京100043 [2]首都医科大学附属北京朝阳医院内分泌科,北京100020

出　　处：《首都医科大学学报》2018年第1期128-132,共5页Journal of Capital Medical University

摘　　要：目的探索能否在糖尿病患者中应用空腹1 h尿钙浓度诊断高尿钙,寻找24 h尿钙(24 hour urine calcium,24 h UCa)的影响因素,建立回归方程,并判断清晨空腹1 h尿钙浓度(1 hour urine calcium,1 h UCa)与24 h UCa的一致性,寻找清晨空腹1 h尿钙浓度最佳诊断切点。方法留取61名在北京朝阳医院内分泌科住院的糖尿病患者24 h尿、随后的空腹1 h尿标本(即6时至7时尿),分别检测24 h尿钙、清晨空腹1 h尿钙浓度,计量24 h尿量,检测25-羟基-维生素D和甲状旁腺激素,应用多元回归分析,寻找24 h UCa的影响因素,建立回归方程,应用Bland-Altman分析法,将清晨空腹1 h尿钙浓度与24 h UCa进行一致性分析。将24 h UCa>350 mg/d选取为诊断切点,以清晨空腹1 h尿钙浓度为检验变量,做受试者工作特征(receiver operating characteristic,ROC)曲线,并且计算其灵敏度、特异度、误诊率。进行配对资料的χ2检验。结果清晨空腹1 h尿钙浓度是24 h尿钙的影响因素,可建立回归方程。Bland-Altman一致性分析显示,清晨空腹1 h尿钙浓度与24 h UCa的一致性好。将24 h UCa>350 mg/d选取为诊断切点,以清晨空腹1 h尿钙浓度为检验变量,做ROC曲线时,曲线下面积为0.925,清晨空腹1 h尿钙浓度选取171.4 mg/L(即4.285 mmol/L)为诊断高尿钙的切点时,灵敏度为100%,特异度为84.9%,误诊率为50%。应用清晨空腹1h尿钙诊断时,8例阳性结果被正常检出,但8例阴性结果成为假阳性。Kappa系数为0.596,提示一致性一般。应用Mc Nemar方法,提示差异有统计学意义。结论在糖尿病患者,由于误诊率高,空腹1 h尿钙浓度不能诊断高尿钙。但是,由于灵敏度高,其可作为初筛试验,阳性者再行24 h UCa检测。Objective To explore if we can replace 24 hour urine calcium（ 24 h UCa） with fasting 1 hour urinary calcium（ 1 h UCa）concentration in diabetes mellitus patients. We explored the factors affecting 24 h UCa,and built the regression equation. Further we judged the agreement of fasting 1 h UCa concentration and 24 h UCa. Finally,we tried to find the best cut-off for fasting 1-hour urinary calcium concentration. Methods Sixty-one diabetes mellitus patients in the endocrine ward of Beijing Chaoyang Hospital,Capital Medical University were invited to attend this test. We collectd the 24 hour urine samples and the following 1 hour urine samples（ fasting condition in 6 to 7 o＇clock）,we detected 24 h UCa,1 h UCa,measured 24 hour urine output,detected 25-OH-vitamin D and parathyroid hormone（ PTH）. We did multiple regression analysis to find the factors affecting 24 h UCa,and built the regression equation. More,we judged agreement of fasting 1 hour urinary calcium concentration and 24 h UCa with Bland-Altman analysis. Finally,we made 24 h UCa 350 mg/d the cut point,and used 1 h UCa to draw receiver operating characteristic（ ROC） curve,evaluated the sensitivity,the specificity,the misdiagnosis rate. Then we made the chi-square test of paired data. Results Fasting 1 h UCa concentration was the factor affecting 24 h UCa. We could build the regression equation. The agreement of fasting 1 h UCa and 24 h UCa was good. When we diagnosed hypercalciuria with 1 h UCa,choosing 24 h UCa 350 mg/d as the cut point to draw ROC curve,the area under the curve is 0. 925. When1 h UCa was 171. 4 mg/L（ 4. 285 mmol/L）,it had the sensitivity of 100% 、the specificity of 84. 9% and the misdiagnosis rate of 50%.When we diagnosed hypercalciuria with 1 h UCa,8 true positives were found,but 8 false positives were diagnosed too. Kappa＇s coefficientwas 0. 596,that meant the agreement was ordinary. And we used Mc Nemar method,the difference was statistically significant. Conclusion In diabetes mellitus patients,because of the

关 键 词：高尿钙 诊断 空腹1 h尿钙浓度 

分 类 号：R587.1[医药卫生—内分泌]