尿N-乙酰-β-D-氨基葡萄糖苷酶 尿视黄醇结合蛋白 尿β_(2)微球蛋白联合检测对乙肝肝硬化患者早期肾损伤诊断的临床价值  

Clinical value of combined detection of urinary NAG RBP andβ2-MG in diagnosis of early renal injury in patients with hepatitis B cirrhosis

作　　者：王钰琛 王勤英[1] Wang Yuchen;Wang Qinying(Department of Infectious Diseases,First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第一医院感染病科,太原030001

出　　处：《中国药物与临床》2021年第22期3671-3674,共4页Chinese Remedies & Clinics

摘　　要：目的分析尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、尿视黄醇结合蛋白(RBP)、尿β_(2)微球蛋白(β_(2)-MG)联合检测对乙肝肝硬化患者早期肾损伤诊断的临床价值。方法收集2019年12月至2020年12月在我院治疗的符合纳入标准和排除标准的且资料完整的乙肝肝硬化患者49例。记录全部入组患者的临床资料,依据CKD-EPI2009SCr公式计算49例患者的肾小球滤过率(eGFR)值,同时检测49例患者的RBP、β_(2)-MG和NAG水平,比较尿RBP、尿β_(2)-MG、尿NAG及3项指标联合检测与计算eGFR值评估早期肾功能变化,并运用受试者工作特征曲线下面积(AUC)评估各指标诊断早期肾损伤的价值。根据Child-Pugh评分将49例患者分为肝硬化代偿期组22例和肝硬化失代偿组27例,比较尿RBP、尿β_(2)-MG、尿NAG及三项联合指标2组患者间评估早期肾功能变化。结果49例乙肝肝硬化患者eGFR异常率为20%(10/49),尿RBP、β_(2)-MG、NAG联合检测异常率为61%(30/49),差异有统计学意义(χ^(2)=16.879,P<0.01);分别计算49例患者尿RBP、β_(2)-MG、NAG的异常率为4%(1/49)、31%(15/49)、45%(22/49),与eGFR值异常率20%(10/49)进行比较,尿NAG异常率与eGFR异常率差异有统计学意义(χ^(2)=6.682,P=0.010),尿RBP、β_(2)-MG异常率与eGFR异常率差异均无统计学意义(P>0.05);计算各指标AUC,3项联合指标AUC=0.819,P=0.002,灵敏度、特异度分别为80%、74%;3项指标联合检测异常率在肝硬化失代偿组患者为74%(20/27)显著高于肝硬化代偿组患者46%(10/22),差异有统计学意义(χ^(2)=4.18,P=0.041),尿NAG异常率在肝硬化失代偿组患者为59%(16/27)高于肝硬化代偿组患者27%(6/22),差异有统计学意义(χ^(2)=5.031,P=0.025),而尿RBP、β_(2)-MG异常率2组差异无统计学意义(P>0.05)。结论尿RBP、β_(2)-MG、NAG三项指标联合检测更能敏感反映乙肝肝硬化患者早期肾功能损伤,尤其是失代偿期肝硬化患者,对于指导临床工作中合理选择抗病毒药物�Objective To determine the clinical value of combined detection of urinary N-acetyl-β-glucosaminidase(NAG),retinol-binding protein(RBP)andβ_(2)microglobulin(β_(2)-MG)in the diagnosis of early renal injury in patients with hepatitis B cirrhosis.Methods Forty-nine patients with hepatitis B cirrhosis,who fulfilled the inclusion and exclusion criteria,treated in our hospital between December 2019 and December 2020,and presented with complete clinical data,were included in the study.The clinical data of these patients were recorded.According to the CKD-EPI2009SCr formula,the eGFR value of 49 patients was calculated.The levels of urinary RBP,β_(2)-MG and NAG in 49 patients were determined.The levels of urinary RBP,β_(2)-MG and NAG and their combined detection were compared with the calculated eGFR value to assess whether there were differences in the evaluation of early renal function changes.The area under the receiver operating characteristic curve(ROC-AUC)was used to evaluate the value of biomarkers for the diagnosis of early renal injury.According to the Child-Pugh score,49 patients were divided into the compensation phase of liver cirrhosis group(n=22)and decompensation phase of liver cirrhosis group(n=27).The levels of urinary RBP,β_(2)-MG and NAG and their combined detection were compared between the two groups to assess whether there were differences in the evaluation of early renal function changes.Results The abnormal rate of eGFR in 49 patients with hepatitis B cirrhosis was 20%(10/49),and that of combined detection of urinary RBP,β_(2)-MG and NAG was 61%(30/49),with statistically significant difference(χ^(2)=16.879,P<0.01).The abnormal rate of urinary RBP,β_(2)-MG and NAG in 49 patients was calculated to be 4%(1/49),31%(15/49)and 45%(22/49),and compared with the abnormal rate of eGFR[20%(10/49)],respectively.There was a statistically significant difference in the abnormal rate between urinary NAG and eGFR(χ^(2)=6.682,P=0.010).There was no significant difference in the abnormal rate between urinary

关 键 词：乙肝肝硬化 早期肾损伤 标志物 

分 类 号：R575.2[医药卫生—消化系统] R692[医药卫生—内科学]