晨尿总蛋白与尿肌酐比值测定在成人慢性肾脏病中的应用

Estimation of daily proteinuria in patients with chronic kidney disease by using the protein-to-creatinine ratio in first-morning urine samples

目的应用晨尿总蛋白与尿肌酐比值评估慢性肾脏病患者尿蛋白排泄率。方法对480例不同肾小球滤过率(GFR)水平的成人慢性肾脏病患者进行晨尿总蛋白与尿肌酐比值测定,并与24 h尿蛋白定量进行相关性分析;采用ROC曲线分析GFR≥10 ml/min患者的晨尿总蛋白与尿肌酐比值相对于24 h尿蛋白定量为0.5 g/24 h、1.0 g/24 h、2.0 g/24 h及3.5 g/24 h的诊断界点。结果 GFR≥10ml/min的慢性肾脏病患者晨尿总蛋白与尿肌酐比值与24 h尿蛋白定量高度正相关(r=0.853,P<0.01)。晨尿总蛋白与尿肌酐比值对应24 h尿蛋白定量为0.5 g/24 h、1.0 g/24 h、2.0 g/24 h及3.5 g/24 h的最佳诊断界点分别为0.46、1.05、2.08及3.16g/gCr。结论在GFR≥10 ml/min的成人慢性肾脏病患者,晨尿总蛋白与尿肌酐比值可替代24 h尿蛋白定量应用于慢性肾脏病患者的蛋白尿定量测定。

Objective To evaluate the clinical application of protein-to-ceratinine ratio（P/CR）in first-morning urine specimens as a predictor of urine portein excretion in patients with chronic kidney disease（CKD）.Methods We measured proteinuria in 480 patients of CKD attending the nephrology clinic by 24-hour urine protein excretion and P/CR in first morning urine.The correlation between P/CR in first-morning urine specimens and urinary protein excretion in 24-hour collections were analyzed.The cutoff values for P/CR in first-morning urine in predicting 24-hour protein threshold excretion of 0.5,1.0,2.0 and 3.5 g/24h were determined by receiver operating characteristic（ROC）curves in patients with GFR≥10ml/min.Results There was a high significant correlation between the urine protein excretion in 24-hour colections and the P/CR in first-morning urine specimens in patients with GFR≥10ml/min.And for patients with Ccr10ml/min.There was a low correlation.The P/CR in first-morning urine of 0.46 g/gCr,1.05g/gCr,2.08g/gCr,3.16g/gCr reliably predicted 24-hour urine total protein equivalent thresholds of 0.5 g/24h,1.0 g/24h,2.0 g/24h and 3.5 g/24h,respectively.Conclusion P/CR in morning-urine specimens is a convenient and reliable marker to estimate the protein excretion of urine in patients of CKD with GFR≥10 ml/min.