尿NAG与ACR联合血清sCys-C检测对2~4期慢性肾脏病并发急性肾衰竭的预警价值  

Early warning value of urine NAG and ACR combined with serum s Cys-C detection in stage 2~4 chronic kidney disease complicated with acute renal failure

作　　者：潘泽斌 张礼萍 郭喜 PAN Zebin;ZHANG Liping;GUO Xi(Department of Nephrology,Jingxian Hospital,Anhui Province Xuancheng Anhui 242500,China)

机构地区：[1]安徽省泾县医院肾病学科,安徽宣城242500 [2]安徽省泾县医院检验科,安徽宣城242500

出　　处：《中国急救复苏与灾害医学杂志》2023年第2期228-231,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：安徽省自然科学基金(编号:ASFC87628)。

摘　　要：目的探究尿N-乙酰β-D氨基葡萄糖苷酶(NAG)、尿微量白蛋白与肌酐比值(ACR)联合血清半胱氨酸蛋白酶抑制剂C(sCys-C)检测对2~4期慢性肾脏病(CKD)并发急性肾衰竭的预警价值。方法选取2018年5月—2021年12月安徽省泾县医院收治的86例2~4期CKD患者为研究对象。统计2~4期CKD患者急性肾衰竭发生情况,并依据是否发生急性肾衰竭分为发生组(21例)和未发生组(65例)。对比发生组和未发生组患者的临床资料。Logistic多因素回归分析影响2~4期CKD患者急性肾衰竭发生的危险因素。制作受试者工作特征曲线(ROC),以曲线下面积(AUC)分析尿NAG、ACR及血清sCys-C三者联合对CKD患者急性肾衰竭发生的预警效能。结果2~4期CKD患者急性肾衰竭发生率为24.42%。发生组合并糖尿病占比、CKD分期为4期占比、合并感染占比、血肌酐、尿酸、尿素氮、甘油三酯、24 h尿蛋白、尿NAG、ACR及血清sCys-C均高于未发生组(P<0.05)。Logistic回归分析结果显示,CKD分期为4期、合并感染、尿NAG、ACR及血清sCys-C均为影响2~4期CKD患者急性肾衰竭发生的独立危险因素(OR=2.751、2.784、3.013、3.347、3.673,P<0.05)。ROC分析显示,尿NAG、ACR及血清sCys-C对2~4期CKD患者急性肾衰竭发生预测的最佳截断点分别为40.81μg/L、684.32、208.75 mg/L,三者联合的特异度为98.46%,高于尿NAG、ACR及血清sCys-C单独进行评估的特异度,且尿NAG、ACR及血清sCys-C三者联合预测2~4期CKD患者急性肾衰竭发生的AUC为0.887,高于尿NAG、ACR及血清sCys-C单独预测的AUC(P<0.05)。结论尿NAG、ACR及血清sCys-C三者联合对2~4期CKD患者急性肾衰竭发生的预警价值较高。Objective To investigate the effect of urinary N-acetylβ-D glucosaminidase(NAG),urinary microalbumin to creatinine ratio(ACR)combined with serum cystatin C(sCys-C)detection on stage 2~4 Early warning value of chronic kidney disease(CKD)complicated by acute renal failure.Methods From May 2018 to December 2021,86patients with stage 2~4 CKD who were admitted to Jingxian Hospital of Anhui Province were selected as the research objects.The incidence of acute renal failure in patients with stage 2~4 CKD was counted and divided into the occurrence group(21 cases)and the non-occurrence group(65 cases)according to whether acute renal failure occurred.The clinical data of the patients in the occurrence group and the non-occurrence group were compared.Logistic multivariate regression analysis of the risk factors for acute renal failure in patients with stage 2~4 CKD.The receiver operating characteristic curve(ROC)was prepared,and the area under the curve(AUC)was used to analyze the early warning efficacy of the combination of urinary NAG,ACR and serum sCys-C on the occurrence of acute renal failure in CKD patients.Results The incidence of acute renal failure in patients with stage 2-4 CKD was24.42%.The proportion of patients with diabetes,the proportion of CKD stage 4,the proportion of infection,serum creatinine,uric acid,blood urea nitrogen,triacylglycerol,24-hour urine protein,urine NAG,ACR and serum sCys-C were higher than those without Occurrence group(P<0.05).Logistic regression analysis showed that CKD stage 4,coinfection,urinary NAG,ACR and serum sCys-C were independent risk factors for acute renal failure in patients with CKD stages 2~4(OR=2.751,2.784,3.013,3.347,3.673,P<0.05).ROC analysis showed that the optimal cut-off points of urinary NAG,ACR and serum sCys-C for predicting the occurrence of acute renal failure in patients with stage 2~4 CKD were 40.81μg/L,684.32 and 208.75 mg/L,respectively.The specificity of urine NAG,ACR and serum sCys-C was 98.46%,which was higher than the specificity of urine NAG,ACR and

关 键 词：慢性肾脏病 急性肾衰竭 N-乙酰β-D氨基葡萄糖苷酶 尿微量白蛋白与肌酐比值 半胱氨酸蛋白酶抑制剂C 

分 类 号：R586[医药卫生—内分泌]