血清胱抑素C联合尿液α1-MG、mALB检测对慢性肾炎早期肾功能损伤的诊断价值分析

Diagnostic Value of Serum Cystatin C Combined with Urine α1-MG and mALB for Early Renal Damage in Patients with Chronic Nephritis

目的 分析血清胱抑素C(Cys-C)联合尿α1-微球蛋白(α1-MG)、尿微量白蛋白(mALB)检测对慢性肾炎早期肾功能损伤的诊断价值。方法 将我院自2014年1月至2018年3月收治的104例慢性肾炎患者纳入研究,并参照K/DOQI进行临床分期;另筛选同期于我院行常规体检的60例健康对象设为对照组,对比其血清Cys-C、尿α1-MG、mALB水平,分析其与肾小球滤过率公式估算值(eGFR)的相关性;并分析血清Cys-C联合尿α1-MG、mALB检测对慢性肾炎早期肾功能损伤的诊断价值。结果 慢性肾炎Ⅰ期、Ⅱ期、Ⅲ期及对照组血清Cys-C、尿α1-MG、mALB比较差异均有统计学意义(P<0.05),且血清Cys-C、尿α1-MG、mALB水平随分期增加而上升(P<0.05);经Pearson相关性分析,血清Cys-C、尿α1-MG及mALB均与eGFR呈负相关(r=-0.823、-0.757、-0.719,P<0.001);以eGFR=60mL/min·1.73m2为肾损伤阀值绘制ROC曲线,单一血清Cys-C、尿α1-MG、尿mALB及联合诊断时,ROC曲线下面积(AUC)为0.805、0.789、0.700、0.904,联合诊断敏感度、特异度、阳性预测值及阴性预测值最佳,依次为86.29%、78.80%、87.29%、67.22%。结论 慢性肾炎早期肾功能损伤,血清Cys-C联合尿α1-MG、mALB检测或具更高的诊断获益,值得临床重视。

Objective To analyze the diagnostic value of serum cystatin C(Cys-C)combined with urine α1-microglobulin(α1-MG)and urine microalbumin(mALB)for early renal damage in patients with chronic nephritis.Methods 104 patients with chronic nephritis who were admitted to the hospital during the period from January 2014 to March 2018 were enrolled in the study.Referring to K/DOQI,clinical staging was carried out.Another 60 healthy subjects who received routine physical examined in the hospital during the same period were selected as the control group.Levels of serum Cys-C,urine α1-MG and urine mALBwere compared,and their correlation with eGFR was analyzed.The diagnostic value of serum cystatin C combined with urine α1-MG and mALB for early renal damage in patients with chronic nephritis was also analyzed.Results There were significant differences in serum Cys-C,urine α1-MG and urine mALB between patients with stage I,stage II and stage III chronic nephritisand control group(P<0.05),and levels of serum Cys-C,urine α1-MG and urine mALB increased with the increase of stage(P<0.05).Pearson correlation analysis showed that serum Cys-C,urine α1-MG and mALB were significantly negatively correlated with glomerular filtration rate(eGFR)(r=-0.823,-0.757,-0.719,all P<0.001).ROC curve was drawn with eGFR=60ml/min/1.73m2as the threshold of renal damage.The areas under ROC curves(AUC)of single serum Cys-C,urine α1-MG,urine mALB and combined diagnosis were 0.805,0.789,0.700and 0.904,respectively.Thesensitivity,specificity,positive predictive valueand negative predictive value of combined diagnosis were the best(86.29%,78.80%,87.29%and 67.22%).Conclusion Serum Cys-C combined with urine α1-MG and urine mALBis of higher diagnostic value for early renal damage in patients with chronic nephritis.