肾损伤标志物在儿童过敏性紫癜性肾炎中的应用价值比较  

Comparison of the Clinical Value of Renal Damage Markers in Renal Dysfunction of Children with Henoch-Schonlein Purpura Nephritis

作　　者：谢连志[1] 练明建 林晖[1] 洪国粦[1] XIE Lianzhi;LIAN MingJian;LIN Hui(Department of Clinical Laboratory,The First Affiliated Hospital of Xiamen University,Xiamen City,Fujian Province 361003)

机构地区：[1]厦门大学附属第一医院检验科,福建省厦门市361003

出　　处：《医学理论与实践》2018年第13期23-25,共3页The Journal of Medical Theory and Practice

摘　　要：目的:评价早期肾功能损伤标志物随机尿微量白蛋白(m ALB)、尿微量白蛋白/肌酐比值(ACR)、尿蛋白(UTP)、ɑ1微球蛋白(ɑ1-microglobulin,ɑ1-M)、β2微球蛋白(β2-microglobulin,β2-M)、尿视黄醇结合蛋白(URBP)、尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)以及24h尿m ALB和血清胱抑素C(Cys C)在儿童过敏性紫癜患者肾功能损伤的诊断价值。方法:选取2015年6月—2017年11月在我院门诊及住院过敏性紫癜患者165例,同时选取同期来我院健康体检的儿童40例为对照组。比较两组所测试得到的数据分析,确定各肾功能损伤标志物对儿童过敏性紫癜的曲线下面积(ROC)和最佳临界值。结果:儿童过敏性紫癜患儿的24h尿m ALB、随机尿(m ALB、ACR、UTP、ɑ1-M、β2-M、URBP、NAG)、血Cys C水平均高于对照组,差异有统计学意义(均P<0.01);ROC曲线结果显示,ACR与24h尿m ALB对儿童过敏性紫癜患者早期肾功能损伤具有较高的诊断价值,其中ROC曲线下面积(AUC)ACR(0.973)最大,其次是24h尿m ALB(0.967);敏感性为ACR(92.4%)最高;ACR与24h尿m ALB相关系数r为0.902,相关性最好。结论:在反映儿童过敏性紫癜肾功能损伤标志物中,ACR最具诊断价值,敏感性最强,ACR与24h尿m ALB高度相关,方便患者检查,可以替代24h尿m ALB检查,值得临床推广。Objective： To evaluate diagnostic value of early renal impairment markers for children with Henoch-Schonlein Purpura nephritis（ HSPN）,including 24 h urine m ALB,random urine（ ACR,UTP,ɑ1-microglobulin,β2-microglobulin,URBP,NAG） and serum cystatin C. Methods： 165 children with HSPN and 40 healthy children were selected from June 2015 to November 2017 in our hospital＇s inpatient and outpatient department. Renal impairment markers were compared between two groups. The area under the curve（ AUC） and the cut-off values were calculated. Results： The urinary m ALB,random urine（ m ALB,ACR,UTP,ɑ1-M,β2-M,URBP,NAG） and Cys C levels in children with henoch-schonlein purpura were significantly higher than those in the control group（ P 0. 01）. The ROC curve showed that ACR and 24-hour urinary m ALB had a high diagnostic value for children with HSPN. The AUC of ACR was 0. 973,followed by 24-hour urinary m ALB（ 0. 967）. The highest sensitivity was ACR＇s（ 92. 4%）. 24-hour urine m ALB has the best correlation with ACR（ r = 0. 902）. Conclusion： Of all the early renal impairment markers,ACR has the best diagnostic value for children with HSPN with high sensitivity. ARC is highly correlated with 24-hour urinary m ALB. Random urine which is convenient for patient to collect,can replace 24-hour urine m ALB. More attention should be paid in the diagnosis of children＇HSPN.

关 键 词：儿童过敏性紫癜 肾功能损伤 标志物 尿微量白蛋白/肌酐比值(ACR) 

分 类 号：R726.9[医药卫生—儿科] R446.1[医药卫生—临床医学]