晨尿蛋白／尿肌酐比值评估CKD患者尿蛋白排泄临床应用评价

Morning spot urine protein -creatinine ratio assent urine protein excretion and their clinical evaluation among CKD patients

目的探讨晨尿蛋白／尿肌酐比值评估CKD患者尿蛋白排泄的临床价值。方法选取住院慢性肾脏病患者136例，检测晨尿蛋白／尿肌酐和24h尿蛋白定量并进行相关性分析；分析GFR、性别、年龄、体重指数对二者相关性的影响，绘制ROC曲线分析确定晨尿蛋白／尿肌酐比值相对于24h尿蛋白定量≥0．15g，24h尿蛋白定量≥1．00g和24h尿蛋白定量≥3．00g的最佳诊断点。结果晨尿蛋白／尿肌酐比值与24h尿蛋白定量呈显著正相关（r=0．83；P〈0．001）；GFR、性别、年龄、体重指数对二者的相关性没有影响；24h尿蛋白定量〉10．15g，24h尿蛋白定量≥1．00g和24h尿蛋白定量≥3．00g时，临床诊断敏感性和特异性最佳点分别为晨尿蛋白／尿肌酐比值≥0．20g／gcr，晨尿蛋白／尿肌酐比值≥0．95g／gcr和晨尿蛋白／尿肌酐比值≥2．92g／gcr。结论晨尿蛋白／尿肌酐比值可替代24h尿蛋白定量，监测肾脏病患者尿蛋白排泄情况。

Objectives To evalute the clinical application of total protein - to - creatinine ratio in spot urine specimens as a predictor of urine protein exeretion among the CKD patients. Methods One hundred and thirty specimens of 24 -hour urine collection, first morning urine specimens from 136 impatients were collected . The correlations between Protein - to - creatinine ratio in first morning urine specimens and urinary protein exeretion in 24 - hour collections were analyzed. Influence about collections between p/c and tpu of factors such as GFR, sex,age and BMI were analyzed. The cutoff values of Protein - to - creatinine ratio in first morning urine specimens for screening urinary proten excretion of 0. 15 g ,1.00g and 3.00g in 24 - hour collection were determined by receiver operating characteristics （ROC） curve. Results There was a significant positive correlation between the urinary protein exeretion in 24 - hour collections and Protein - to - creatinine ratio in first morning urine specimens. Such factors GFR,sex ,age and BMI have nothing to do with the collection between p/c and tpu. urine protein exeretion in 24 - hour collections≥0.15 g, urine protein exeretion in 24 - hour collections t〉 1.00g and urine protein exeretion in 24 -hour collections≥3.00g, corresponding Protein- to- creatinine ratio clinical diagnosis best sensitive and specific spot：Protein - to - creatinine ratio ≥0.20g/gcr, Protein - to - creatinine ratio ≥0. 95g/gcr, Protein - to - creatinine ratio ≥ 2.92 g/gcr. Conclusions The Protein - to - creatinine ratio in spot urine samples can used as an alternative to urine protein excertion in 24 - hour collections in patients.