Cys-C、β2-MG及mAlb/Cr联合检测在原发性 肾病综合征患儿急性肾损伤中的诊断价值

Clinical value of serum cystatin C,β2-microglobulin,microalbuminuria/urinary creatinine combined detection in the diagnosis of acute kidney injury in children with primary nephrotic syndrome

目的探讨血清胱抑素C(Cys-C)、β2-微球蛋白(β2-MG)、尿微量蛋白/尿肌酐(mAlb/Cr)联合检测在原发性肾病综合征(PNS)患儿急性肾损伤(AKI)诊断中的临床价值。方法回顾性分析潜江市中心医院肾病风湿科2018年1月至2022年1月期间收治的60例PNS患儿病例资料,其中男35例、女25例,年龄(9.24±2.51)岁,根据是否出现AKI分为AKI组(27例)和非AKI组(33例)。对比两组患儿临床资料[性别、年龄、体质量指数(BMI)、血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血肌酐(Scr)、血清白蛋白(ALB)、尿酸(UA)、24 h尿蛋白(24 h Up)、血红蛋白(Hb)、β2-MG、CysC、mAlb/Cr]。采用多元logistic回归方程分析PNS患儿发生AKI的危险因素,采用受试者工作特征曲线(ROC)分析Cys-C、β2-MG及mAlb/Cr联合检测诊断PNS患儿发生AKI的临床价值。采用t检验、χ^(2)检验。结果AKI组患儿Scr[(87.04±13.32)μmol/L]、UA[(275.53±58.14)μmol/L]、24 h Up[(150.24±37.83)mg/24 h]、Cys-C[(2.25±0.53)mg/L]、β2-MG[(1.46±0.25)mg/L]、mAlb/Cr水平[(36.70±10.35)μg/mg]均高于非AKI组[(71.95±11.91)μmol/L、(221.07±43.56)μmol/L、(120.52±28.62)mg/24 h、(1.62±0.32)mg/L、(1.18±0.21)mg/L、(22.32±6.51)μg/mg],ALB水平[(34.72±2.34)g/L]低于非AKI组[(37.39±2.72)g/L],差异均有统计学意义(均P<0.05)。Cys-C、β2-MG及mAlb/Cr升高均为PNS患儿发生AKI的危险因素(均P<0.05)。Cys-C、β2-MG及mAlb/Cr联合检测诊断PNS患儿发生AKI的曲线下面积(AUC)、灵敏度及特异度(0.885、88.89%、81.82%)均优于单一指标检测(均P<0.05)。结论Cys-C、β2-MG及mAlb/Cr联合检测诊断PNS患儿发生AKI具有较好的应用价值。

Objective To investigate the clinical value of serum cystatin C(Cys-C),β2-microglobulin(β2-MG),microalbuminuria/urinary creatinine(mAlb/Cr)combined detection in the diagnosis of acute kidney injury(AKI)in children with primary nephrotic syndrome(PNS).Methods The clinical data of 60 children with PNS in Department of Nephropathy and Rheumatism,Qianjiang Central Hospital from January 2018 to January 2022 were retrospectively analyzed,including 35 males and 25 females,aged(9.24±2.51)years.The children were divided into an AKI group(27 cases)and a non-AKI group(33 cases)according to the presence or absence of AKI.The clinical data such as gender,age,body mass index(BMI),serum total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),serum creatinine(Scr),serum albumin(ALB),uric acid(UA),24 h urinary protein(24 h Up),hemoglobin(Hb),β2-MG,CysC,and mAlb/Cr were compared between the two groups.The risk factors of AKI in the children with PNS were analyzed by multivariate logistic regression equation,and the clinical value of Cys-C,β2-MG,and mAlb/Cr combined detection in the diagnosis of AKI in children with PNS was analyzed by receiver operating characteristic curve(ROC).t test andχ^(2) test were used.Results The levels of Scr[(87.04±13.32)μmol/L],UA[(275.53±58.14)μmol/L],24 h Up[(150.24±37.83)mg/24 h],Cys-C[(2.25±0.53)mg/L],β2-MG[(1.46±0.25)mg/L],and mAlb/Cr[(36.70±10.35)μg/mg]in the AKI group were higher than those in the non-AKI group[(71.95±11.91)μmol/L,(221.07±43.56)μmol/L,(120.52±28.62)mg/24 h,(1.62±0.32)mg/L,(1.18±0.21)mg/L,and(22.32±6.51)μg/mg],while the level of ALB[(34.72±2.34)g/L]was lower than that of the non-AKI group[(37.39±2.72)g/L],with statistically significant differences(all P<0.05).Increased Cys-C,β2-MG,and mAlb/Cr were risk factors for AKI in children with PNS(all P<0.05).The area under the curve(AUC),sensitivity,and specificity(0.885,88.89%,and 81.82%)of Cys-C,β2-MG,and mAlb/Cr combined detection in the diagnosis of AKI in children with PNS were superior to those of single index detection(all P<0.05).Conclusion The combined detection of Cys-C,β2-MG,and mAlb/Cr in the diagnosis of AKI in children with PNS has a good clinical value.