慢性肾脏病患者晨尿白蛋白/肌酐比值与尿蛋白定量、定性的相关性分析  

Quantitative and Qualitative Analysis of the Correlation between Morning Urinary Albumin/Creatinine Ratio and Urinary Protein in Patients with Chronic Kidney Disease

作　　者：李培雄 石咏军 LI Peixiong;SHI Yongjun(Guangdong Medical University,Zhanjiang City,Guangdong Province 524023)

机构地区：[1]广东医科大学,广东省湛江市524023

出　　处：《医学理论与实践》2022年第12期1997-2001,1996,共6页The Journal of Medical Theory and Practice

摘　　要：目的:研究慢性肾脏病(CKD)患者晨尿白蛋白/肌酐比值(ACR)与24h尿蛋白定量(24hUP)、尿蛋白定性(QUP)间的关系。方法:本研究纳入我院肾内科2020年12月—2021年11月收治的门诊和住院CKD患者总共589例,根据肾小球滤过率进行肾功能分期分组。首先,采用Spearman秩相关分析探讨ACR与24hUP的相关性,并采用线性回归方程模拟24hUP和ACR的关系;然后,根据临床蛋白尿分级治疗的需要,分别以24hUP=0.15g、0.5g、1g、3.5g为参考,通过ROC曲线分析得出相对应的敏感性和特异性最佳的ACR诊断界值;最后,将QUP分为0(-)、0.5(±)、1(+)、2(++)、3(+++)、4(++++)共6个等级,采用Spearman秩相关性分析探讨ACR与QUP的相关性,并比较两者联合与单一指标的诊断效能。结果:Spearman秩相关分析显示:CKD 1~5期患者晨尿ACR与24hUP值均存在正相关性(r=0.830,r_(1)=0.899,r_(2)=0.902,r_(3)=0.759,r_(4)=0.739,r_(5)=0.652,P<0.05);然后,将各组晨尿ACR与24hUP值对数转换后应用IBM SPSS26.0软件绘制lg(ACR)与lg(24hUP)散点图,从而得到拟合线性回归方程分别为y=1.64+0.56x(R^(2)=0.676,P<0.05),y_(1)=1.62+0.59x_(1)(R^(2)=0.776,P<0.05),y_(2)=1.51+0.63x_(2)(R^(2)=0.776,P<0.05),y_(3)=1.64+0.54x_(3)(R^(2)=0.567,P<0.05),y_(4)=1.44+0.61x_(4)(R^(2)=0.640,P<0.05),y_(5)=1.12+0.68x_(5)(R^(2)=0.473,P<0.05)。同时,以24hUP=0.15g、0.5g、1.0g、3.5g为定量诊断蛋白尿的金标准,ROC曲线分析得出对应的晨尿ACR诊断界值分别为50μg/mg、213.5μg/mg、544μg/mg、1667μg/mg,此时敏感性和特异性最佳。另外,以24hUP=150mg/24h作为尿蛋白阳性的诊断标准,采用二元Logistic回归计算QUP和晨尿ACR联合诊断尿蛋白阳性的概率P,绘制P的ROC曲线并计算曲线下面积,分别与QUP、晨尿ACR相比较。P、晨尿ACR和QUP的曲线下面积分别为0.962、0.959、0.910,95%可信区间分别为(0.945,0.980)、(0.940,0.978)、(0.881,0.940)。结论:CKD患者晨尿ACR与24hUP显著正相关,其相关性不受肾功能分期的显著Objective:To study the morning albumin/creatinine ratio(ACR)and 24-hour urine protein quantification(24hUP)and the qualitatiation of urinary protein(QUP)in patients with chronic kidney disease(CKD).Methods:A total of 589 outpatients and inpatients with CKD who were admitted to the department of Nephrology of our hospital from December 2020 to November 2021 were enrolled in this study.Renal function was divided into three groups according to glomerular filtration rate.Firstly,Spearman rank correlation analysis was used to explore the correlation between ACR and 24hUP,and linear regression equation was used to simulate the relationship between 24hUP and ACR.Then,according to the needs of clinical proteinuria grading treatment,using 24hUP=0.15g,0.5g,1g,3.5g as the reference,the corresponding sensitivity and specificity of the best ACR diagnostic threshold was obtained by ROC curve analysis.Finally,QUP was divided into 6 grades:0(-),0.5(±),1(+),2(++),3(+++)and 4(++++).Spearman rank correlation analysis was used to explore the correlation between ACR and QUP,and the diagnostic efficacy of the two indexes was compared.Results:Spearman rank correlation analysis showed that there was a positive correlation between ACR and 24hUP value in morning urine in CKD 1~5 patients(r=0.830,r_(1)=0.899,r_(2)=0.902,r_(3)=0.759,r_(4)=0.739,r_(5)=0.652,P<0.05);then,lg(ACR)and lg(24hUP)scatter plots were plotted using IBM SPSS26.0 software after logarithmic conversion of ACR and 24hUP values in morning urine of each group.The fitting linear regression equations were y=1.64+0.56x(R^(2)=0.676,P<0.05),y_(1)=1.62+0.59x_(1)(R^(2)=0.776,P<0.05),y_(2)=1.51+0.63x_(2)(R^(2)=0.776,P<0.05),y_(3)=1.64+0.54x_(3)(R^(2)=0.567,P<0.05),y_(4)=1.44+0.61x_(4)(R^(2)=0.640,P<0.05),y_(5)=1.12+0.68x_(5)(R^(2)=0.473,P<0.05).At the same time,with 24hUP=0.15g,0.5g,1.0g and 3.5g as the gold standard for quantitative diagnosis of proteinuria,ROC curve analysis showed that the corresponding threshold values of morning urine ACR were 50μg/mg,213.5μg/mg,544μg/mg an

关 键 词：慢性肾脏病 晨尿白蛋白/肌酐比值 24H尿蛋白定量 尿蛋白定性 

分 类 号：R446[医药卫生—诊断学] R692[医药卫生—临床医学]