摘要
目的分析IgA肾病(immunoglobulin A nephropathy,IgAN)患者的24 h尿蛋白定量、随机尿微量白蛋白/肌酐比值和晨尿蛋白半定量水平,评价3种尿蛋白检测方法的相关性和一致性。方法IgAN患者84例,留取患者随机尿,检测随机尿微量白蛋白和尿肌酐,记录患者晨尿蛋白半定量和24 h尿蛋白定量结果。采用Pearson和Spearman相关性分析不同尿蛋白检测方法的相关性,采用组内相关系数(intraclass correlation coefficient,ICC)评价不同尿蛋白检测方法的一致性。根据肾小球滤过率(estimated glomerular filtration rate,eGFR)水平分为训练集组[eGFR<90 mL/(min·1.73m2)]49例和验证集组[eGFR≥90 mL/(min·1.73 m2)]35例,比较2组临床资料;采用训练集组数据绘制ROC曲线,确定反映24 h尿蛋白定量≥1 g/d的随机尿微量白蛋白/肌酐比值的界值,计算界值判定24 h尿蛋白定量≥1 g/d的灵敏度和特异度;采用验证集组数据进行内部验证。结果IgAN患者随机尿微量白蛋白/肌酐比值与24 h尿蛋白定量呈正相关(r=0.718,P<0.001),具有较好一致性(ICC=0.356,P<0.001);晨尿蛋白半定量与24 h尿蛋白定量呈正相关(r=0.719,P<0.001),一致性较差(ICC=0.051,P=0.185)。随机尿微量白蛋白/肌酐比值为314.62 mg/g时,判定24 h尿蛋白定量≥1 g/d的AUC为0.863(95%CI:0.778~0.947,P<0.001)。以其近似值300 mg/g为界值,随机尿微量白蛋白/肌酐≥300 mg/g时判定24 h尿蛋白定量≥1 g/d的灵敏度为100.0%,特异度为78.6%。以验证集组数据进行内部验证,随机尿微量白蛋白/肌酐比值≥300 mg/g时,判定24 h尿蛋白定量≥1 g/d的灵敏度为82.4%,特异度为77.8%。结论IgAN患者24 h尿蛋白定量与随机尿微量白蛋白/肌酐比值和晨尿蛋白半定量均呈正相关,其中随机尿微量白蛋白/肌酐比值与24 h尿蛋白定量水平一致性较好;无论患者肾功能是否受损,随机尿微量白蛋白/肌酐比值≥300 mg/g可一定程度提示IgAN患者24 h尿蛋白定量水平≥1 g/
Objective To analyze the levels of 24-h urinary protein quantification,random urinary microalbumin/creatinine and semi-quantification of morning urinary protein in patients with immunoglobulin A nephropathy(IgAN)and to evaluate their correlation and consistency.Methods Eighty-four patients with IgAN were enrolled.The urinary albumin and creatinine were detected in randomly collected urine,and semi-quantification of morning urinary protein and 24-h urinary protein quantification were recorded.Pearson correlation coefficient and Spearman correlation coefficient were used to analyze the correlation,and intraclass correlation coefficient(ICC)was used to evaluate the consistency in different methods of urinary protein detection.According to estimated glomerular filtration rate(eGFR),84 patients were divided into 49 patients with eGFR of<90 mL/(min·1.73 m2)(training set)and 35 patients with eGFR of≥90 mL/(min·1.73 m2)(validation set).The clinical data were compared between two groups.ROC curve was drawn by using the training set to determine the threshold value of random urinary microalbumin/creatinine reflecting 24-h urinary protein quantification≥1 g/d.The sensitivity and specificity of 24-h urinary protein quantification≥1 g/d were determined by calculating the threshold value.Validation set data were used for internal validation.Results There was a positive correlation between the random urinary microalbumin/creatinine and 24-h urinary protein quantification(r=0.718,P<0.001),and a good consistency(ICC=0.356,P<0.001),while there was a positive correlation between semi-quantification of morning urinary protein and 24-h urinary protein quantification(r=0.719,P<0.001),but a poor consistency(ICC=0.051,P=0.185).When the random urinary microalbumin/creatinine was 314.62 mg/g,the AUCfor determination of 24-h urinary protein quantification≥1 g/d was0.863(95%CI:0.778-0.947,P<0.001).When the threshold value of random urinary microalbumin/creatinine was≥300 mg/g,the sensitivity and specificity for determination of
作者
崔少远
段姝伟
张岩
汪鹏
朱晗玉
蔡广研
陈香美
CUI Shao-yuan;DUAN Shu-wei;ZHANG Yan;WANG Peng;ZHU Han-yu;CAI Guang-yan;CHEN Xiang-mei(Department of Nephrology,the First Medical Center,Chinese PLA General Hospital,State Key Laboratory of Kidney Diseases,National Clinical Research Center for Kidney Diseases,Beijing 100853,China)
出处
《中华实用诊断与治疗杂志》
2021年第6期621-624,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
北京市科技计划课题(D181100000118004,D181100000118002)
国家重点实验室专项(2011DAV00088)。
关键词
IGA肾病
随机尿微量白蛋白/肌酐比值
晨尿蛋白半定量
24
h尿蛋白定量
immunoglobulin A nephropathy
random urinary microalbumin/creatinine
semi-quantification of morning urinary protein
24-h urinary protein quantification
