尿蛋白/肌酐比与24-h尿蛋白定量在肾小球疾病尿蛋白水平测量中的一致性评价  

Consistency evaluation of urine PCR and 24-h urine protein quantification in urine protein evaluation of glomerular disease patients

作　　者：陈香慧 贾婷 杨莹[1,2] 李艳[1,2] 魏世卓 王佳琪[1,2] 冯莹莹 马芳霞 陈钊[1,2] 王莉[1,2] 付荣国[1,2] Chen Xianghui;Jia Ting;Yang Ying;Li Yan;Wei Shizhuo;Wang Jiaqi;Feng Yingying;Ma Fangxia;Chen Zhao;Wang Li;Fu Rongguo(Department of Nephrology,The Second Affiliated Hospital of Xi an Jiaotong University,Xi an 710004,China;Urology and Nephrology Hospital of the Second Affiliated Hospital of Xi an Jiaotong University,Xi an 710004,China)

机构地区：[1]西安交通大学第二附属医院肾病科,西安710004 [2]西安交通大学第二附属医院泌尿肾脏病院,西安710004

出　　处：《首都医科大学学报》2024年第5期831-837,共7页Journal of Capital Medical University

基　　金：国家自然科学基金项目(82000699,82170697);陕西省科技厅社发攻关重点项目(2023-YBSF-330);陕西省卫生健康学科带头人访学研修项目。

摘　　要：目的评价尿蛋白/肌酐比值(protein/creatinine ratio,PCR)与24-h尿蛋白定量(24-h urine total protein,24-h UTP)在肾小球疾病患者蛋白尿定量检测中的一致性。方法选取2024年3月至2024年7月在西安交通大学第二附属医院住院的急、慢性肾小球肾炎以及肾病综合征等肾小球疾病患者作为研究对象,收集患者的年龄、性别、原发病、尿量、血常规、肝肾功能、血脂等临床资料,并记录尿常规、晨尿PCR以及24-h UTP等数据。多元线性回归筛选可显著影响PCR和24-h UTP结果的指标,据其对患者进行分组,并应用Bland-Altman分析以及组内相关性系数(intraclass correlation efficient,ICC)分别评价各组中两种测量指标的一致性。结果本研究共纳入患者220例,其中男性129例,女性91例,平均年龄(53.21±17.68)岁,PCR与24-h UTP间存在显著正相关(Spearman相关系数为0.83,P<0.001)。多元线性回归提示,尿量及血清白蛋白(albumin,ALB)水平可影响24-h UTP结果,而PCR结果不受尿量的影响,但却受到估算肾小球滤过率(estimated glomerular filtration rate,eGFR)以及ALB的影响。Bland-Altman分析显示,在24-h尿量1500~2500 mL、eGFR在30~89 mL·(min·1.73 m^(2))^(-1),或者ALB≥30g/L的患者中,两个指标具有较好的一致性。应用ICC进一步对各组中两个指标的一致性进行了定量,提示血ALB水平和尿量可能是影响两个指标一致性的因素。结论尿PCR和24-h UTP两种蛋白尿检测指标尽管具有高度的相关性,但其一致性及互相可替代性则需要结合患者的尿量、血清白蛋白以及eGFR水平等来进行综合的判断。Objective To evaluate the consistency between urine protein/creatinine ratio(PCR)and 24-h urine total protein(24-h UTP)in measuring proteinuria levels in patients with glomerular diseases.Methods Patients with acute and chronic glomerulonephritis,nephrotic syndrome,and other glomerular diseases admitted to the Second Affiliated Hospital of Xi an Jiaotong University from March 2024 to July 2024 were selected as the research subjects.Clinical data such as age,gender,primary disease,urine output,blood routine,liver and kidney function,and blood lipids were collected.The results of morning urine PCR and 24-h UTP were also recorded.Multiple linear regression was applied to select indicators that significantly affect PCR and 24-h UTP.Patients were grouped based on these indicators,and Bland-Altman analysis and intraclass correlation efficient(ICC)were applied to evaluate the consistency of the two measurement indicators in each group.Results A total of 220 patients were included in this study,including 129 males and 91 females,with an average age of(53.21±17.68)years old.The Spearman correlation coefficient between 24-h UTP and PCR was 0.83(P<0.001).Multiple linear regression showed that urine volume and serum albumin(ALB)levels could affect the results of 24-h UTP,while PCR results were not affected by urine volume but were influenced by estimated glomerular filtration rate(eGFR)and ALB levels.Bland Altman analysis suggests that for patients with urine output of 1500-2500 mL,eGFR between 30-89 mL·(min·1.73 m^(2))^(-1),or ALB levels≥30g/L,the two indicators have good consistency in detecting urinary protein levels.ICC further quantified the consistency of two indicators in each group,suggesting that ALB levels and urine volume may be factors affecting the consistency of the two indicators.Conclusions Although there is a significant correlation between urinary PCR and 24-h UTP results,their consistency and mutual substitutability require comprehensive judgment based on the patient s urine volume,ALB,and eGFR levels

关 键 词：尿蛋白/肌酐比值 24-h尿蛋白定量 一致性 

分 类 号：R692.6[医药卫生—泌尿科学] R446[医药卫生—外科学]