肾功能损伤早期实验室指标的诊断价值比较

The diagnostic value of early renal damage laboratory index in comparison

目的:评价肾功能损伤实验室早期诊断指标的诊断价值。方法:肾内科的住院患者和肾内科门诊患者86例,同时测定入院患者的血清胱抑素C(Cys C)、血清肌酐(Cr)和血清尿素氮(UREA)等指标。按照诊断学(第六版)进行分组,通过分析特征工作曲线(ROC)评价它们对于诊断肾功能损伤的价值进行比较分析。结果:根据肾功能分为3组,A组(肾功能正常对照组Ccr≥80 mL/min)的Cvs C、Cr和UREA分别为(0.47±0.24)mg/L、(85±14)μmol/L和(4.55±1.33)mmol/L。B组(肾功能储备下降期和肾功能不全期20 mL/min≤Ccr<80 mL/min)的Cys C、Cr和UREA分别为(1.59±1.29)mg/L、(214±173)μmol/L和(11.04±8.24)mmol/L。和C组(肾功能衰竭期和尿毒症期Ccr<20 mL/min)的Cys C、Cr和UREA分别为(3.47±0.75)mg/L、(669±466)μmol/L和(21.22±13.10)mmol/L。随Ccr的下降,Cys C、Scr和UREA浓度上升,三者与Ccr呈负相关。根据Youden指数为最大值时,Cys C、Cr和UREA的诊断临界值分别为0.90 mg/L、115μmol/L和7.33 mmol/L时,计算在诊断肾功能损伤时的敏感性(%)、特异性(%)、阳性预测值(%)、阴性预测值(%)、诊断准确性(%)和ROC曲线面积(AUC)分别为Cys C(77.3%,97.6%,97.0%,81.1%,87.5%,0.908)、Cr(65.9%,97.6%,96.5%,74.1%,81.8%,0.817)、和UREA(63.6%,97.6%,96.4%,72.8%,80.6%,0.785),诊断准确度结果显示Cys C>Cr>UREA。三者的ROC曲线面积(AUC)为0.908、0817和0.785。Cys C的AUC(0.908)最高,达到较好的诊断效果。结论:肾功能损伤实验室早期诊断指标中,Cys C有着较高灵敏度和特异性,具有较高的诊断价值。

Objective To investigate the diagnostic value of laboratory evaluation of renal injury in early diagnosis index.Methods Eighty-six patients in in-patient and out-patient of the department of urology were tested in serum C（Cys C）,serum creatinine（Cr） and serum UREA nitrogen（UREA）.According to the diagnostics（sixth edition）,we evaluated their values for diagnosis of renal injury by analyzing the characteristics of the work curve（ROC）.Results According to the renal function indexes,3 groups were divided such as group A（normal renal function control Ccr 80 mL/min） or the Cys C,Cr,and UREA in（0.47±0.24） mg/L,（85±14） μmol/L,and（4.55 ± 1.33） mmol/L,group B（a decrease in renal function reserves,and renal insufficiency 20 mL/min or less Ccr 〈80 mL/min） of Cys C,Cr,and UREA in（1.59 ± 1.29） mg/L,（214 ± 173） μmol/L,and（11.04 ±8.24） mmol/L and group C（renal failure and uremia Ccr 〈20 mL/min） of Cys C,Cr,and UREA in（3.47 ±0.75） mg/L,（669 ± 466） μmol/L,and（21.22 ± 13.10） mmol/L respectively.As reducing in Ccr,Cys C,Scr and UREA concentration increased and correlated with Ccr negatively.According to the mazimum Youden index,the critical values of Cys C,Cr,and UREA were 0.90（mg/L）,115（｜JLmol/L） and 7.33（mmol/L） separately,the sensitivity（%）,specificity,positive predictive value（%）,negative predictive value（%）,diagnostic accuracy（%） and the area of the ROC curve（AUC） were Cys C（77.3%,97.6%,97.0%,81.1%,77.3%,0.908）,Cr（65.9%,97.6%,96.5%,74.1%,65.9%,0.817）,and UREA（63.6%,97.6%,96.4%,72.8%,63.6%,0.785）respectively.The diagnostic accuracy showed that the Cys C 〉Cr〉 UREA.Their correspounding ROC curve（AUC） were in the area of 0.908,and 0.785 and 0817.Cys C had the highest AUC（0.908）,and achieved a good diagnosis effect.Conclusion Renal damage laboratory indexes of in the early diagnosis,Cys C has a higher sensitivity and specificity to be worth of clinical promotion.