血清和24h尿液Tamm-Horsfall蛋白、骨桥蛋白对泌尿系统结石的诊断价值  

Diagnostic value of Tamm-Horsfall protein and osteopontin in serum and 24-hour urine for urolithiasis

作　　者：宋小雨 秦东芳 杨静[1] 张婵媛 崔亮[2] 靖万林[2] 张海红 张萌[2] 熊颖 朱海峰[4] 王学晶 SONG Xiaoyu;QIN Dongfang;YANG Jing;ZHANG Chanyuan;CUI Liang;JING Wanlin;ZHANG Haihong;ZHANG Meng;XIONG Ying;ZHU Haifeng;WANG Xuejing(Department of Clinical Laboratory,Peking University Civil Aviation School of Clinical Medicine,Beijing 100123,China;Department of Urology,Peking University Civil Aviation School of Clinical Medicine,Beijing 100123,China;Department of ULtrasound,Peking University Civil Aviation School of Clinical Medicine,Beijing 100123,China;Department of Medical Imaging,Peking University Civil Aviation School of Clinical Medicine,Beijing 100123,China)

机构地区：[1]北京大学民航临床医学院检验科,北京100123 [2]北京大学民航临床医学院泌尿外科,北京100123 [3]北京大学民航临床医学院超声科,北京100123 [4]北京大学民航临床医学院影像科,北京100123

出　　处：《临床检验杂志》2024年第10期733-737,共5页Chinese Journal of Clinical Laboratory Science

基　　金：首都卫生发展科研专项(2022-2-6031)。

摘　　要：目的探讨血清和24 h尿液Tamm-Horsfall蛋白(THP)、骨桥蛋白(OPN)对泌尿系统结石的诊断价值。方法纳入2020年4月至2023年3月于民航总医院泌尿外科行输尿管软镜取石术的结石患者101例和同期健康人50例。收集2组研究对象的血清和24 h尿液标本,应用酶联免疫吸附试验(ELISA)测定THP、OPN水平。Logistic回归分析各指标与泌尿系统结石的相关性,绘制ROC曲线评估其诊断效能。结果结石组24 h尿THP[20.13(13.12,26.03)mg/d]、OPN[51.24(36.72,101.37)μg/d]和血清THP[182.01(160.91,209.20)ng/mL]、OPN[18.76(15.72,22.48)ng/mL]水平均显著低于对照组(P均<0.001)。二元Logistic回归分析显示,24 h尿THP(OR=0.736,95%CI:0.606~0.895)、OPN(OR=0.975,95%CI:0.958~0.993)、枸橼酸(OR=0.067,95%CI:0.012~0.376)和血清THP(OR=0.946,95%CI:0.908~0.986)、OPN(OR=0.896,95%CI:0.803~0.999)是泌尿系统结石的保护因素,而24 h尿钙(OR=2.125,95%CI:1.243~3.633)是其危险因素(P均<0.05)。ROC曲线分析显示,上述6个指标单独诊断泌尿系统结石的ROC曲线下面积(AUC^(ROC))分别为0.846、0.809、0.786、0.823、0.748、0.755,而血清THP+OPN、24 h尿THP+OPN和6个指标联合诊断的AUC^(ROC)分别为0.882、0.920和0.984,诊断效能更优。结论血清和24 h尿液THP、OPN水平联合检测对结石具有较好的诊断价值,有望作为诊断泌尿系统结石的生物标志物。Objective To investigate the diagnostic value Tamm-Horsfall protein(THP)and osteopontin(OPN)in serum and 24-hour urine for urolithiasis.Methods A total of 101 patients with urolithiasis who underwent flexible ureteroscopy lithotripsy at the Urology Department of Civil Aviation General Hospital from April 2020 to March 2023 were included as the stone group,and 50 healthy individuals were enrolled as the control group.The samples of serum and 24-hour urine samples were collected from both the groups,and the levels of THP and OPN were measured using enzyme-linked immunosorbent assay(ELISA).Logistic regression analysis was performed to evaluate the association between each biomarker and urolithiasis,and receiver operating characteristic(ROC)curves were plotted to assess their diagnostic value.Results The stone group showed significantly lower THP levels(20.13[13.12,26.03]mg/d)and OPN levels(51.24[36.72,101.37]μg/d)in 24-hour urine,and THP levels(182.01[160.91,209.20]ng/mL)and OPN levels(18.76[15.72,22.48]ng/mL)in serum compared to the control group(all the P<0.001).Binary Logistic regression analysis revealed that THP(OR=0.736,95%CI:0.606-0.895),OPN(OR=0.975,95%CI:0.958-0.993)and citrate(OR=0.067,95%CI:0.012-0.376)in 24-hour urine,and THP(OR=0.946,95%CI:0.908-0.986)and OPN(OR=0.896,95%CI:0.803-0.999)in serum were the protective factors for urolithiasis,while calcium level(OR=2.125,95%CI:1.243-3.633)24-hour urine was a risk factor(all the P<0.05).ROC curve analysis showed that the areas under the curve(AUC^(ROC))for the individual diagnosis of urolithiasis were 0.846,0.809,0.786,0.823,0.748,and 0.755 for the above six biomarkers,respectively.The AUC^(ROC) for the combined diagnosis u sing THP+OPN in serum,THP+OPN in 24-hour urine and all the six biomarkers were 0.882,0.920 and 0.984,respectively,indicating better diagnostic performance.Conclusion The combined detection of the THP and OPN levels in serum and 24-hour urine may have good diagnostic value for urolithiasis and serve as potential diagnostic biomarkers.

关 键 词：泌尿系统结石 TAMM-HORSFALL蛋白 骨桥蛋白 生物标志物 

分 类 号：R446[医药卫生—诊断学]