联合尿液标记物检测在高血压早期肾损害诊断中的临床应用研究

Clinical application of combined urine markers detection in the diagnosis of patients with hypertension early renal damage

目的 探讨尿视黄醇结合蛋白（RBP）、尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）、尿胱蛋白酶抑制剂C（Cystatin C）和微量白蛋白（mALB）的联合测定对原发性高血压早期肾损害诊断的敏感性及临床意义.方法 选择2014年9月至2015年6月在新疆自治区人民医院肾病科住院的原发性高血压患者52例作为观察组,另设健康体检者30例为对照组.尿RBP、Cys-tatin C和mALB测定采用酶联免疫法（ELISA）检测,尿NAG测定采用对硝基苯酚（PNP）比色法检测.结果 观察组中尿RBP、NAG、Cystatin C和mALB的含量明显高于正常对照组（P＜0.001）,通过ROC曲线、诊断试验结果显示：尿NAG、RBP的曲线下面积分别为0.952、0.932,95％可信区间分别为0.911 ～0.993、0.875 ～0.981,较尿Cystatin C和mALB更具有敏感性（P＜0.001）.联合尿RBP、NAG、Cystatin C和mALB检测的曲线下面积为0.971,95％可信区间分别为0.946 ～1.000,差异具有统计学意义（P＜0.001）.结论 联合检测尿NAG、RBP、CystatinC和mALB有助于高血压肾损害的早期监测,对预防高血压性肾病的发生、发展具有重要的临床价值.

Objectives To explore the clinical significance and sensitivity of combined detection of the urine retinol conjugated protein（RBP）,N-acetyl-β-D-amino grape glycosidase （NAG）,urine micro proteinase inhibitor C（Cystatin C） and mALB in the diagnosis of patients with hypertension early renal damage.Methods From September 2014 to June 2015,52 patients with essential hypertension as observational group and 30 healthy examination persons as control group were selected in our hospital.Urine RBP,Cystatin C,mALB and NAG levels were detected by enzyme-linked immunosorbent method and nitro phenol（PNP） colorimetric method.Results The urine RBP,Cystatin C,mALB and NAG levels of cases in observational group were higher than that of control group（P 〈0.001）.The ROC curve and diagnostic test results showed that the area under the curve（AUC） of urine NAG,RBP was 0.952%,0.932% and 95% CI was 0.911 ～ 0.993,0.875 ～ 0.981 respectively（P 〈 0.001）,which had hjgher sensitivity compared with urine Cystatin C and mALB（P 〈0.001）;Combined detection of urine RBP,NAG,Cystatin C and mALB had the AUC of 0.971 and95% CI of0.946～1.000（P 〈0.001）.Conclusions Combined detection of urine markers would help monitor for patients with hypertension early renal damage and it has important clinical significance in the prevention of hypertensive nephropathy.