尿微量蛋白联合检测对慢性肾病早期肾损伤诊断的临床应用价值

Clinical application value of urinary trace proteins combined detection in the diagnosis of early renal injury in chronic kidney diseases

目的探讨尿微量蛋白联合检测对慢性肾病早期肾损伤诊断的临床应用价值。方法将2015年8月~2018年8月就诊于湖北省中医院(以下简称“我院”)且临床确诊为慢性肾病的521例患者作为病例组,计算估算的肾小球滤过率(eGFR)并按照分期标准分为五组,包括Ⅰ期(222例)、Ⅱ期(130例)、Ⅲ期(105例)、Ⅳ期(39例)、Ⅴ期(25例),另选86名我院健康体检者作为正常对照组。分别检测6项尿微量蛋白[尿视黄醇结合蛋白(URBP)、尿微量白蛋白(UmAlb)、β2-微球蛋白(Uβ2M)、转铁蛋白(TRF)、免疫球蛋白(UIgG)和尿N-乙酰-β-D氨基葡萄糖甘酶(UNAG)]和血清肌酐,比较各组检测结果,分析尿微量蛋白指标相关性、诊断效能及与慢性肾病分期的关联度和一致性,评价标志物单一及联合检测对于慢性肾病早期肾损伤诊断的临床应用价值。结果病例组患者6项尿微量蛋白水平均高于正常对照组,随着慢性肾病病程的进展呈明显升高趋势,差异有高度统计学意义(P<0.01)。URBP与Uβ2MG、UTRF与UmAlb显著相关(rp=0.789、0.940)。UmAlb、UTRF与UIgG三者显著相关(均rp>0.6)。Uβ2MG和URBP与eGFR、肾病分期相关性较好,其他指标相关性中等,UNAG最差。尿微量蛋白5项指标单项检测结果与慢性肾病分期关联度不高,一致性一般(均Kappa值<0.4)。尿微量蛋白指标联合检测的诊断效能优于单项指标(AUC>0.958),并联模式的关联度和一致性均优于串联模式。结论尿微量蛋白各有生物学特点,在评估慢性肾病早期肾损伤时各具优势。尿微量蛋白联合检测具有较高的诊断效能,可显著提高诊断效率,对慢性肾病肾损伤的早期诊断、病理分型、分期监测、预后评估具有较高的临床实用价值。

Objective To investigate the clinical application value of urinary trace proteins combined detection in the diagnosis of early renal injury in chronic kidney diseases.Methods According to calculated estimated glomerular filtration rate(eGFR)and staging criteria,521 patients with clinically diagnosed chronic kidney diseases were enrolled and divided into five groups including phaseⅠ(222 cases),phase Ⅱ(130 cases),phase Ⅲ(105 cases),phaseⅣ(39 cases),phaseⅤ(25 cases)in Hubei Provincial Hospital of Traditional Chinese Medicine(“our hospital”for short)from August 2015 to August 2018,while another 86 healthy subjects of our hospital were selected as normal control group.Six urinary trace proteins[Urine retinol binding protein(URBP),urine microalbumin(UmAlb),urine beta 2-microglobulin(Uβ2M),urine transferrin(UTRF),urine immunoglobulin(UIgG)and urine N-acetyl-beta-D glucosamine(UNAG)]and serum creatinine were detected respectively.The results of each group were compared,while analysed the relevance and diagnostic efficiency of urinary trace proteins,and their correlation and consistency with the stages of chronic kidney diseases.The clinical application value of single and combined detection of these markers in the diagnosis of early renal injury in chronic kidney diseases were evaluated.Results The levels of six urinary trace proteins in chronic kidney disease group were higher than those in normal control group,while increased significantly with the progression of disease,and the differences were highly statistically significant(P<0.01).The relevance of URBP and Uβ2MG as well as UTRF and UmAlb(rp=0.789,0.940)was high.Moreover,urinary trace protein UmAlb,UTRF and UIgG reflecting glomerular injury were well interrelated(all rp>0.6).Grade correlation analysis showed that Uβ2MG and URBP were significantly correlated with eGFR and stages of nephropathy,while other proteins were moderately correlated.However,UNAG was the worst.The correlation between six urinary trace proteins and the stages of chronic kidney diseases was ordinary,and the consistency was general(all Kappa<0.4).The diagnostic efficiency of urinary trace proteins combined detection was not only superior to that of single index(AUC>0.958),but also superior to that of serial mode in terms of correlation and consistency with the stages of chronic kidney diseases.Conclusion Urinary trace proteins have their own biological characteristics,and each of them has its own advantages in evaluating early renal injury in chronic kidney diseases.The combined detection of urinary trace proteins has high diagnostic performance and can significantly improve the diagnostic efficiency.It has high clinical application value for early diagnosis,pathological classification,staging monitoring and prognosis evaluation of renal injury in chronic kidney diseases.