尿液白蛋白干化学法与微量白蛋白^(125)I法对肾功能损伤的诊断价值比较  

Albumin urine dry chemistry method and the method of trace albumin ^(125)I compare the diagnostic value of renal injury

作　　者：王敏[1] 黄海樱[2] 陈波[2] 陈靖楠 WANG Min;HUANG Haiying;CHEN Bo;CHEN Jingnan(Department of Pediatrics,Guangzhou Women and Children Medical Center,Guangdong Province,Guangzhou 510620,China;Department of Clinical Laboratory,the Second Affiliated Hospital of Guangzhou Medical University,Guangdong Province,Guangzhou 510260,China)

机构地区：[1]广州市妇女儿童医疗中心儿内科,广东广州510620 [2]广州医科大学附属第二医院检验科,广东广州510260

出　　处：《中国当代医药》2023年第29期146-149,154,共5页China Modern Medicine

基　　金：广东省医学科研基金立项项目(B2015040);广东省建设中医药强省科研课题(20151286);广东省广州市建设国家级科技思想库研究课题专项项目(2015SX027)。

摘　　要：目的比较不同尿液微量白蛋白检测方法对肾功能损伤的诊断价值。方法选取2020年6月至2021年6月广州医科大学附属第二医院收治的631例患者作为研究对象,患者的留取全部尿液标本(包括随机尿和24 h尿),采用干化学法和碘125I放射免疫分析法(RIA)分别检测尿常规中的尿蛋白(PRO)、尿微量白蛋白(mAlb)和24 h尿微量白蛋白排泄率(UAER),按UAER的值分为无肾损伤组(UAER≤20μg/min)261例;肾损伤组(UAER>20μg/min)370例,通过非参数检验的秩和检验以及利用ROC曲线对两组的常规尿液肾功能指标进行评价,分析根据约登指数(YI)为最大值时,PRO和mAlb^(①)与mAlb^(②)误诊率在<5%(即特异度>95%)的情况下的其敏感度、特异度、阳性预测值、阴性预测值、诊断准确性、AUC和诊断临界值。结果两组患者的PRO和随机尿mAlb比较,差异有统计学意义(P<0.01)。根据PRO和随机尿mAlb实验室诊断指标的受试者工作特征(ROC)曲线下面积(AUC)分别为0.694和0.967,根据YI指数为最大值时,PRO的诊断临界值在0.15 g/L,其敏感度、特异度、阳性预测值、阴性预测值和诊断准确性分别为44.90%、93.10%、86.68%、62.82%和69.00%。随机mAlb^(①)(YI为最大值)的诊断临界值在10.30 mg/L,其敏感度、特异度、阳性预测值、阴性预测值和诊断准确性分别为90.50%、90.80%、90.77%、90.53%和90.65%,可以得出随机mAlb的敏感度、特异度和诊断准确性均较高(>90%)。当随机mAlb^(②)(即特异度>95%)的误诊率满足小于5%的情况下,其的诊断临界值在13.29 mg/L,其敏感度、特异度、阳性预测值、阴性预测值和诊断准确性分别为84.90%、95.00%、94.44%、86.29%和89.95%。结论在肾功能损伤中随机尿mAlb的诊断准确性优于PRO;诊断临界值不同时诊断准确度结果大小为mAlb^(①)>mAlb^(②)>PRO。PRO法简单、快速对临床具有一定的筛查价值,假阳性率偏高,需进一步验证;但存在一定的漏诊率(6.9%)�Objective To compare the urine micro protein value to the diagnosis of renal damage detection methods.Methods A total of 631 patients admitted to the Second Affiliated Hospital of Guangzhou Medical University from June 2020 to June 2021 were selected as the study objects.All urine samples(including random urine and 24-hour urine)were collected.Urinary protein(PRO),urinary microalbumin(mAlb)and urinary microalbumin excretion rate(UAER)at 24 h were detected by dry chemical method and iodo-125I radioimmunoassay(RIA),respectively.According to the value of UAER,261 cases were divided into no renal injury group(UAER≤20μg/min).In 370 cases of renal injury group(UAER>20μg/min),the rank sum test of non-parametric test and ROC curve were used to evaluate the conventional urine renal function indexes of the two groups,and the analysis was conducted when the maximum value of Yoden index(YI)was calculated.Sensitivity,specificity,positive predictive value,negative predictive value,diagnostic accuracy,AUC,and diagnostic critical value of PRO and mAlb^(①)and mAlb^(②)with misdiagnosis rates<5%(i.e.,specificity>95%).Results The difference of PRO and random urinary mAlb between the two groups was statistically significant(P<0.01).The area under receiver operating characteristic(ROC)curve(AUC)of PRO and random urine mAlb laboratory diagnostic indicators were 0.694 and 0.967,respectively.When YI index was the maximum,the diagnostic critical value of PRO was 0.15 g/L.The sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy were 44.90%,93.10%,86.68%,62.82%and 69.00%,respectively.When the diagnostic critical value of random mAlb^(①)(YI being the maximum)was 10.30 mg/L,the sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy were 90.50%,90.80%,90.77%,90.53%and 90.65%,respectively.It can be concluded that the sensitivity,specificity and diagnostic accuracy of random mAlb are high(>90%).When the misdiagnosis rate of random mAlb^(②)(i.e

关 键 词：尿微量白蛋白 干化学 放免法 肾功能损伤 

分 类 号：R563.1[医药卫生—呼吸系统]