尿蛋白定性和定量及尿清蛋白与总蛋白比值临床价值研究

Correlation between Urine Qualitative Test and Protein Quantitation and Clinical Value of Urine Albumin/Protein Ratio in Proteinuria

目的：比较尿蛋白定性和定量的三个指标干化学法尿蛋白、尿清蛋白、尿总蛋白及尿清蛋白与总蛋白比值应用于蛋白尿筛查的研究。方法选取2015年10月～2016年7月于首都医科大学附属北京安贞医院就诊患者282例新鲜样本，分别进行尿蛋白干化学试纸法、尿清蛋白和尿总蛋白定量分析。比较尿蛋白干化学试纸法各组区分尿蛋白的能力。研究检测尿蛋白三个指标的相关关系。最后分析尿清蛋白与总蛋白比值在正常清蛋白尿、轻度清蛋白尿、大量清蛋白尿之间的差异。结果①尿蛋白干化学试纸法结果为－，±，＋，＋＋，＋＋＋组对应的尿清蛋白、尿总蛋白及尿清蛋白与总蛋白比值分别为21.91±6.23，145.60±26.82，457.11±81.63，3957.48±1171.65，4300±1445.11 mg／L；114.02±4.87，233.86±23.39，718.05±100.98，6347.62±2023.12，8527.43±1291.39 mg／L；16.58％±1.26％，30.79％±3.60％，55.98％±4.31％，67.70％±4.20％，75.44％±4.93％。除弱阳性组外，尿蛋白干化学定性阳性各组与阴性组相比，尿清蛋白和尿总蛋白定量结果之间的差异均有统计学意义（F＝68.196～81.66，P值均＜0.01）；尿蛋白干化学阳性各组与阴性组相比，尿清蛋白与总蛋白比值之间的差异均有统计学意义（F＝46.63，P＜0.001）。②尿清蛋白／肌酐低于30 mg／g时，干化学蛋白定性、尿清蛋白、总蛋白相关性较差（尿清蛋白、尿总蛋白与尿蛋白干化学试纸法 Spearman系数分别为0.049，0.225，P＝0.534，P＜0.01；尿清蛋白与总蛋白Pearson相关系数为0.684，P＜0.01）；尿清蛋白／肌酐高于30 mg／g时，三者相关性良好（尿清蛋白、尿总蛋白与干化学蛋白定性Spearman系数分别为0.736和0.806，P值均＜0.01；尿清蛋白与总蛋白Pearson相关系数为0.989，P＜0.01）。③正常清蛋白尿组、轻度清蛋白尿组和大量清蛋白尿组比较，其尿清蛋白与总蛋白比值之间的差异均有统计学意义（F＝365.266，P＜0.01）。结论干化学尿蛋白定性无法正确区分尿蛋白阴性和弱阳性。可以采用尿清蛋白与总蛋白比值在高危人群中筛查蛋白尿。

Objective To investigate the correlation between urine albumin,urine protein and qualitative urine protein and di-agnostic value of urine albumin/protein ratio in proteinuria.Methods Urine albumin,protein and qualitative urine protein of 282 patients in Beijing Anzhen Hospital during October 2015 to July 2016 were detected.The difference of urine albumin,u-rine protein and urine albumin/protein ratio between groups were analyzed according to qualitative urine protein test.Then the correlations between urine albumin,urine protein and qualitative urine protein were analysed.Finally,the difference of u-rine albumin/protein ratio between normal albuminuria,mild albuminuria,macro albuminuria was analyzed.Results ①Ac-cording to qualitative urine protein results “-,± ,＋,＋＋,＋＋＋”,corresponding urine albumin and protein and urine al-bumin/protein ratio were 21.91 ± 6.23,145.60 ± 26.82,457.11 ± 81.63,3 957.48 ± 1 171.65,4 300 ± 1 445.11 mg/L;114.02±4.87,233.86 ± 23.39,718.05 ± 100.98,6 347.62 ± 2 023.12,8 527.43 ± 1 291.39 mg/L;16.58%± 1.26%, 30.79%±3.60%,55.98%±4.31%,67.70%±4.20%,75.44%±4.93%.There was significant difference in urine albu-min and protein between positive groups and negative group except for trace positive group.There was significant difference in urine albumin/protein ratio between positive groups and negative group.②When ACR was lower than 30 mg/g,the corre-lation between protein dipstick test results and urine albumin and urine protein was poor （Spearman’s correlation coefficient were 0.049 and 0.225,P=0.534,P〈0.01.Pearson correlation coefficient was 0.684,P〈0.01）,while the correlation was better when ACR was above 30 mg/g （Spearman’s correlation coefficient were 0.736 and 0.806,P〈0.01.Pearson’s corre-lation coefficient were 0.989,P〈0.01）.③There was significant difference in urine albumin/protein ratio between normal albuminuria,mild albuminuria and macro albuminuria （F=365.266,P〈0.01）.Conclusion It is hard for protein dipstick test to distinguish negative and trace protein urine.Urine albumin/protein ratio can be used to screen for high risk popula-tion.