视黄醇结合蛋白、血清胱抑素C在慢性肾脏病中的诊断价值

Diagnostic value of retinal-binding protein, serum cystatin C in chronic kidney disease

目的探讨视黄醇结合蛋白(retinal-binding protein,RBP)和血清胱抑素C(cystatin C,Cys C)等肾功能指标在慢性肾脏病(chronic kidney disease,CKD)患者中的变化及临床意义。方法收集141例CKD患者作为病例组并检测其血清Cys C、β_2-微球蛋白(β_2-microglobulin,β_2-MG)、RBP、尿微量白蛋白/肌酐比值(urinary albumin-to-creatinine tatio,UACR)及相关肾功能指标,同时收集23例健康体检的正常者作为对照组,分析各生化指标变化特点及相关性,并绘制ROC曲线判断各指标及多指标联合检测早期慢性肾脏病的敏感度及特异性。结果 Cys C和β_2-MG从CK D 2期开始与对照组比较差异有统计学意义(P<0.05),尿RBP从CKD 3a期起与对照组比较有差异有统计学意义(P<0.05)。血清RBP、尿RBP、Cys C、β_2-MG和UACR与肾小球滤过率(glomendar filtration rate,e GFR)呈负相关,与肌酐(creatinine,Cr)、尿素(urea nitrogen,Urea)呈正相关。ROC曲线显示UACR、尿RBP、Cys C和β_2-MG诊断CKD早期肾损伤的准确性较高,而4项指标的联合检测在诊断早期慢性肾脏病时具有较高的灵敏度及特异性。结论 UACR、尿RBP、血清Cys C及β_2-MG能够诊断早期肾损伤,4项指标的联合检测对于慢性肾脏病的早期诊断具有重要的临床意义。

Objective To explore the diagnostic value of cystatin C(CysC),retinal-binding protein and other indicators of kidney function in different stages of chronic kidney disease(CKD).Methods A total of141patients with CKD were collected as the case group while another23cases of normal adults served as the control group.The levels of serum Cys C,β2-MG,RBP,URBP,UACR and other indicators of kidney function were detected.The sensitivity and specificity of each indicator in the early pathological changes were evaluated with ROC curves.Results The levels of serum Cys C andβ2-MG were significantly higher from stage2of CKD than those in the control group(P<0.05).The level of URBP was significantly higher than that in the control group from stage3a of CKD(P<0.05).RBP,Cys C,β2-MG and UACR had a positive correlation with Cr as well as Urea,but a negative correlation with eGFR.The ROC curves showed that UACR,URBP,Cys C andβ2-MG had higher accuracy in the early diagnosis of CKD.Conclusion Kidney damage can be diagnosed early by detecting UACR,URBP,serum CysC andβ2-MG,and simultaneous detection of them can be of great clinical significance for early diagnosis of CKD.