CRP、Hcy和Cys C指标在痛风患者肾功能损伤诊断中的意义

Diagnostic significance of CRP,Hcy and Cys C for early renal damage in patients with gout

目的对痛风肾损伤患者的CRP、Hcy和Cys C指标进行检测,以证实其在痛风患者肾损伤中的诊断价值。方法选取2014年5月—2016年12月本院风湿免疫科108例住院及门诊随访的符合纳入标准的痛风患者为研究对象,并依据GFR水平分为痛风合并肾功能损伤组(A组,n=40),痛风非肾功能损伤组(B组,n=68)。另取同期35名我院体检中心的健康人为C组。收集两组患者的晨尿及空腹静脉血标本,检测血清中尿酸(Serum Uric Acid,SUA)、血清肌酐(Serum Creatinine,Scr)、血尿素氮(Blood Urea Nitrogen,BUN)、C反应蛋白(C Reactive Protein,CRP)、同型半胱氨酸(Homocysteine,Hcy)及胱抑素C(Cystatin C,Cys C)的水平;检测尿蛋白及尿肌酐(Urine Creatinine,Ucr)的水平。结果 A组患者的BUN、Scr、SUA、Cys C、CRP及Hcy水平显著高于B、C两组,内生肌酐清除率(Ccr)则显著低于B、C两组(P<0.05);B组患者的BUN、Scr、SUA、Cys C、CRP及Hcy水平显著高于C组,Ccr则显著低于C组(P<0.05)。诊断痛风患者早期肾损伤的过程中,当以8.05 mg/L为CPR的临界值时,诊断的敏感性可达84.76%,特异性为80.63%,诊断指数达1.7205,AUC可至0.867;当以13.08μmol/L为Hcy的临界值时,诊断的敏感性可达83.85%,特异性为81.52%,诊断指数达1.6298,AUC可至0.786;当以1.00μmol/L为Cys C的临界值时,诊断的敏感性可达86.86%,特异性为84.79%,诊断指数达1.6857,AUC可至0.852。结论 CRP、Hcy及Cys C单独检测对于痛风患者早期肾损伤的诊断均有一定临床意义,而CRP综合优势更明显。

Objective To explore the diagnostic significance of CRP, Hcy and Cys C for early renal injury in patients with gout.Methods 108 patients with gout, those who were hospitalized in the rheumatology department or followed up in the outpatient of our hospital during May 2014 and December 2016, were selected as study subjects. They patients were divided into gout combined with renal function injury group （group A, n= 40） and Non renal function injury group （group B, n = 68） according to GFR level. 35 cases of healthy people those who received health examination in the medical examination center were chose as C group. The serum uric acid （SUA） , serum creatinine （Scr） , blood urea nitrogen （ BUN ） , C reactive protein （ CRP ） , Homocysteinc （Hey）, Cystatin C （Cys C）, urine protein and Urine Creatinine （Ucr） of the three groups were measured and compared respectively. Results The levels of BUN, Set, SUA, Cys C, CRP and Hcy in group A were significantly higher than those in group B and C （P〈0.05）. The level of Ccr in group A was significantly lower than that in group B and C （P〈0.05）. The levels of BUN, Scr, SUA, Cys C, CRP and Hey in group B were significantly higher than those in group C （P〈0.05） , the level of Ccr in group B was significantly lower than that in group C （ P 〈 0. 05 ）. When 8.05 mg/L was taken as CPR cutoff point, the diagnosis sensitivity for gout combined with renal function injury diagnosis was 84. 76% and the specificity was 80. 63%, the maximum diagnostic index reached 1.7205, ROC area under the curve was 0.867. When 13.08 μmol/L was taken as Hey threshold, the sensitivity was 83.85% and the specificity was 81.52%, with the maximum diagnostic index 1.6298 and ROC area 0.786. Whenl.00 μmol/L was taken as Cys C threshold, the sensitivity was 86.86% and the specificity was 84.79%, with the maximum diagnostic index 1. 6857 and ROC area 0. 852. Conclusions The detection of CRP, Hcy and Cys C respectively have clinical significance for the diagnosis of early renal injury in gout patients in a certain extent, while CRP has a more comprehensive advantage.