实验室常用指标在肾病中的应用分析

Analysis of application of common laboratory indexes in kidney diseases

目的探讨实验室检测在肾病中的应用价值,评估这些标记是否可以预测肾组织学病变,筛选出适合临床的最佳检验组合。方法收集该院2010年12月至2014年3月117例肾活检患者主要的临床资料、病理类型及实验室检查等指标,根据WHO肾脏病理分级标准和Katafuchi半定量积分标准进行分级(Ⅰ、Ⅱ、Ⅲ、Ⅳ级)分组。比较分析各组血清胱抑素C(CysC)、尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG),尿α1微球蛋白(α1-MG)、尿微量清蛋白(mAlb)和24尿蛋白(U-TP)水平的差异性与肾小球、肾小管间质病理变化的关系;以及各项检测指标在不同分组中的相关性和统计学意义。结果病理分级第Ⅳ级的NAG、α1-MG和CysC与第Ⅰ、Ⅱ、Ⅲ级比较均有统计学意义(P<0.05),U-TP和mAlb在反映肾脏疾疾时具有显著相关性(r=0.565,P=0.000);NAG和α1-MG在反映肾小管间质疾病时也具有显著相关性(r=0.509,P=0.000)。结论各项检测指标的检测结果上升到一定高度时可以判断患者临床与病理病情进展,说明病情的严重情况;同时根据指标间的相关性和检测效能,筛选Cys C、mAlb、α1-MG 3个指标联合检测,检测效能大大改进。

Objective To investigate the value of laboratory testing in kidney diseases and to assess whether these marks can predict the renal histological lesions for screening the best clinical test combination.Methods The main clinical data,pathological types and laboratory examination indexes in 117 patients with renal biopsy in our hospital from December 2010 to March 2014 were collected and graded according to the WHO renal pathological classification standard and the Katafuchi semi-quantitative score standard classification （Ⅰ,Ⅱ,Ⅲ,Ⅳ）.The differences in serum CysC,urine NAG,urine alpha 1-MG,urine mAlb and 24 h urine total protein （24h-UTP）level were compared among the various groups and their relations with the glomerulus was analyzed;the correlation and the statistical significance of each index in different groups was analyzed.Results NAG,alpha 1-MG and CysC had statistical differences between in the grade Ⅳgroup and the gradeⅠ,Ⅱ,Ⅲ groups （P 〈0.05）,24h-UTP and mAlb had significant correlation in reflecting the kidney diseases （r=0.565,P =0.000）;NAG and alpha 1-MG also had significant correlation in reflec-ting renal tubular interstitial disease （r=0.509,P =0.000）.Conclusion The detection results of various detection indicators when rising to a certain height can be used for judging the progression of the patients clinical and pathological condition,illustrating the serious condition of illness;at the same time according to the correlation among the indexes and the detection efficiency,three indi-cators of Cys C,mAlb,alpha 1 - MG are screened out for conducting the combination detection,the detection efficiency could be greatly improved.