肾功能、尿蛋白及血清白蛋白对慢性肾脏病患者血清肿瘤标记物水平的影响

Effect of Renal Function, Urine Protein and Serum Albumin on the Serum Tumor Marker Level of Patients with Chronic Kidney Diseases

目的探讨不同肾小球滤过率(e GFR)及尿蛋白、血清白蛋白对慢性肾脏病(CKD)患者血清甲胎蛋白(AFP)、癌胚抗原(CEA)、糖蛋白抗原199(CA199)、糖蛋白抗原125(CA125)水平的影响。方法检测2016年1—6月方便选取在江苏大学附属医院肾内科住院的125例患者的血清AFP、CEA、CA199、CA125水平,根据其肾小球滤过率、24 h尿蛋白定量以及血清白蛋白浓度进行分组,并对数据进行统计学分析。结果 (1)CEA在慢性肾脏病1~5分期的平均值分别为(2.16±1.27)、(1.68±0.82)、(3.35±2.18)、(3.55±1.89)、(4.27±2.72)μg/L,不同分期间差异有统计学意义(P<0.05),且e GFR越低,CEA水平越高(r=-0.458)。(2)CA199在24 h尿蛋白定量<1.5 g/d组、1.5~3.5 g/d组和≥3.5 g/d组的平均值分别为(6.77±5.38)、(10.28±9.67)、(14.67±8.80)U/m L,各组间差异有统计学意义(P<0.05),且24 h尿蛋白定量越多,CA199水平越高(r=0.364);CA125在不同24 h尿蛋白定量的平均值分别为(14.70±8.64)、(25.54±23.70)、(24.03±9.88)U/m L,各组间差异有统计学意义(P<0.05),且24 h尿蛋白定量越多,CA125水平越高(r=0.509)。(3)CA199在血清白蛋白<25 g/L组、25~35 g/L组和≥35 g/L组的平均值分别为(14.62±8.62)、(10.38±8.85)、(7.97±7.97)U/m L,各组间差异有统计学意义(P<0.05),且血清白蛋白越高,CA199水平越低(r=-0.324);CA125不同血清白蛋白的平均值分别为(38.51±27.40)、(18.40±10.20)、(15.43±8.76)U/m L,各组间差异有统计学意义(P<0.05),且血清白蛋白越高,CA125水平越低(r=-0.472)。结论慢性肾脏病患者在肾功能严重减退、大量蛋白尿及低白蛋白血症情况下,通过血清肿瘤标记物辅助诊断相应肿瘤时特异性降低。

Objective To study the effect of e GFR, urine protein, serum albumin on the CKD, AFP, CEA, CA199 and CA125 levels. Methods Convenient selection the serum AFP, CEA, CA199, CA125 levels of 125 cases of inpatients in our hospital from January to June 2016 were tested and divided into groups according to the e GFR, 24 h urine protein quantification and serum albumin concentration, and the data were statistically analyzed. Results The average values of CEA in 1~5 stage of the chronic kidney diseases were respectively(2.16±1.27),(1.68±0.82),(3.35±2.18),(3.55±1.89),(4.27±2.72)μg/L,and the difference was statistically significant(P<0.05), and the lower the e GFR, the higher the CEA level(r=-0.458), and the average values of CA199 in the 24 h urine protein quantification < 1.5 g/d group, 1.5 ~3.5 g/d group and ≥3.5 g/d group were respectively(6.77±5.38),(10.28±9.67),(14.67±8.80)U/m L, and the differences were statistically significant(P<0.05), and the more the 24 h urine protein quantification, the higher the CA199 level(r=0.364), and the average values of CA125 in the different 24 h urine protein quantifications were respectively(14.70±8.64),(25.54±23.70),(24.03±9.88)U/m L,and the differences were statistically significant(P<0.05), and the more the 24 h urine protein quantification, the higher the CA125 level(r=0.509), the average values of CA199 in the serum albumin <25 g/L group, 25~35 g/L group and ≥35 g/L group were respectively(14.62±8.62),(10.38±8.85),(7.97±7.97)U/m L, and the differences were statistically significant(P<0.05), and the higher the serum albumin, the lower the CA199 level(r=-0.324), and the average values of CA125 in different serum albumin were respectively(38.51±27.40),(18.40±10.20)U/m L,(15.43±8.76)U/m L, and the differences were statistically significant(P<0.05), and the higher the serum albumin, the lower the CA125 level(r=-0.472). Conclusion The specificity of adjunctive diagnosis of corresponding tumors by the serum tumor markers decreases under the conditions of severely impaired renal function, massive proteinuria and hypoalbuminemia of patients with chronic kidney diseases.