联合uCr、Cys-C、uMA检测在多发性骨髓瘤合并早期肾脏损害中的诊断

Combined detection of uCr,Cys-C and uMA in the diagnosis of multiple myeloma complicated with early renal damage

目的分析联合尿肌酐(uCr)、血清胱抑素-C(Cys-C)、尿微量白蛋白(uMA)检测在多发性骨髓瘤(MM)合并早期肾脏损害中的诊断价值。方法收集保定市第二中心医院2017年1月至2021年1月收治的123例MM患者,其中合并肾脏损伤者39例(合并肾脏损伤组,CCr≤80 mL/min),未合并肾脏损伤者84例(未合并肾脏损伤组,CCr>80 mL/min)。比较两组uCr、Cys-C及uMA水平变化情况,分析上述因子与内生肌酐清除率(CCr)的相关性。绘制受试者工作特征曲线(ROC),分析uCr、Cys-C及uMA对MM合并早期肾脏损伤的诊断价值。结果合并肾脏损伤组uCr水平明显低于未合并肾脏损伤组,Cys-C、uMA水平高于未合并肾脏损伤组,差异具有统计学意义(P<0.05)。相关性分析显示,uCr与CCr呈正相关(P<0.05),Cys-C、uMA与CCr均呈显著负相关(P<0.05)。在CCr 50~80 mL/min时,Cys-C与CCr相关性优于uCr、uMA。ROC曲线分析结果显示,uCr、Cys-C及uMA联合检测MM合并早期肾脏损伤的下曲线面积(Area under curve,AUC)、敏感度、特异度均明显高于单一检测(P<0.05)。结论uCr、Cys-C及uMA与MM合并早期肾脏损伤患者肾功能损伤程度密切相关,综合检测各项指标可提高对MM早期肾脏损伤的诊断价值。

Objective To analyze the value of combined detection of urinary creatinine(uCr),serum cystatin-C(Cys-C)and urinary microalbumin(uMA)in the diagnosis of multiple myeloma(MM)combined with early renal damage.Methods The clinical data of 123 patients with MM admitted to Baoding Second Central Hospital from January 2017 to January 2021 were collected,including 39 patients with renal injury(combined kidney injury group,CCr≤80 mL/min),and those without renal injury 84 cases(no kidney injury group,CCr>80 m L/min).The changes in the levels of uCr,Cys-C and uMA were compared between the two groups.The correlation between the above factors and the endogenous creatinine clear rate(CCr)was analyzed.The receiver operating characteristic curve(ROC)was drawn to analyze the value of uCr,Cys-C and uMA in the diagnosis of MM combined with early kidney injury.Results The level of uCr in the group with kidney injury was significantly lower than that in the group without kidney injury,and the levels of Cys-C and uMA were higher than those in the group without kidney injury.The difference was statistically significant(P<0.05).Correlation analysis showed that uCr was positively correlated with CCr(P<0.05),and both Cys-C and u MA were significantly negatively correlated with CCr(P<0.05).The correlation between Cys-C and CCr was better than that of uCr and u MA when CCr was 50~80 m L/min.The ROC curve analysis results showed that the area under curve(AUC),sensitivity,and specificity of the combined detection of uCr,Cys-C and uMA in the diagnosis of MM combined with early kidney damage were significantly higher than those of single detection.Conclusion uCr,Cys-C and uMA are closely related to the degree of renal function damage in patients with MM combined with early renal injury.Comprehensive detection of various indicators can improve the diagnostic value of early renal injury combined with MM.