血清iPTH、ALB、hs-CRP、A/G水平对慢性肾脏病合并肾性贫血的预测价值

Predictive value of serum iPTH,ALB,hs-CRP,and A∕G levels in chronic kidney disease complicated with renal anemia

目的 探讨血清全段甲状旁腺激素(iPTH)、白蛋白(ALB)、超敏C反应蛋白(hs-CRP)、白蛋白/球蛋白(A/G)水平对慢性肾脏病(CKD)并发肾性贫血的预测价值。方法 选取2021年10月~2023年10月在资中县人民医院就诊的123例CKD合并肾性贫血患者为CKD贫血组,以血红蛋白(Hb)含量分为重度组、中度组以及轻度组;以同期CKD未合并肾性贫血患者123例作为CKD未贫血组。检测所有患者血清iPTH、ALB和hs-CRP、计算A/G水平;Pearson法分析患者血清iPTH、ALB、hs-CRP、A/G水平与Hb的相关性;采用ROC曲线分析血清iPTH、ALB、hs-CRP、A/G水平单独及联合对CKD合并肾性贫血患者的预测价值;logistic回归分析影响CKD合并肾性贫血的因素。结果 与CKD未贫血组相比,CKD贫血组血清iPTH、hs-CRP、透析龄显著增加[(60.29±8.63)pg/ml vs.(46.44±4.66)pg/ml、(2.01±0.29)mg/L vs.(1.53±0.19)mg/L、(3.68±1.04)年vs.(3.37±0.82)年],而ALB、A/G水平显著降低[(32.25±3.33)g/L vs.(38.93±3.90)g/L、(1.46±0.24)vs.(1.99±0.37)],差异有统计学意义(t=15.661、15.355、1.759、14.446、13.328,P<0.05)。轻度组、中度组及重度组患者血清iPTH、hs-CRP水平依次升高[(52.52±4.76)、(60.38±5.84)、(72.80±6.54),(1.72±0.20)、(2.01±0.30)、(2.49±0.44)],ALB、A/G依次降低[(36.28±3.62)、(31.92±3.36)、(26.85±2.67),(1.83±0.32)、(1.46±0.24)、(0.72±0.11)],差异有统计学意义(F=83.575、41.793、53.456、124.980,P<0.05)。Pearson法分析显示,血清iPTH、hs-CRP与Hb呈负相关(r=-0.560、-0.503,P<0.05),ALB、A/G水平与Hb呈正相关(r=0.535、0.574,P<0.05);血清iPTH、ALB、hs-CRP、A/G水平以及透析龄均为CKD合并肾性贫血发生的影响因素(P<0.05);血清iPTH、ALB、hs-CRP、A/G水平预测CKD合并肾性贫血的曲线下面积分别为0.774、0.749、0.715、0.737,敏感度分别为60.98%、87.80%、72.36%、86.99%,特异度分别为88.62%、52.03%、62.60%、56.91%;四者联合预测CKD合并肾性贫血的曲线下面积、敏感度、特异度分别为0.867、78.05%、92.68%。结论 血清iPTH、hs-CRP、ALB、A/G水平与CKD患者贫血程度相关,四者联合检测对CKD并发肾性贫血具有一定的预测价值。

Objective To investigate the predictive value of serum whole parathyroid hormone(iPTH),albumin(ALB),high-sensitivity C-reactive protein(hs-CRP),albumin∕globulin(A∕G)in chronic kidney disease(CKD)complicated by renal anemia.Methods 123 CKD patients with renal anemia who visited from October 2021 to October 2023 were selected as the CKD anemia group.They were divided into severe group,moderate group,and mild group based on hemoglobin(Hb)content.123 CKD patients without concomitant renal anemia during the same period were selected as the CKD non anemia group.The serum iPTH,ALB,hs CRP,and A∕G levels were measured.Pearson's method was used to analyze the correlation between serum levels of iPTH,ALB,hs CRP,A∕G,and Hb in patients.The predictive value of serum iPTH,ALB,hs CRP,A∕G levels alone and in combination for CKD patients with renal anemia was analyzed using ROC curve analysis.Logistic regression analysis of factors affecting renal anemia in CKD patients.Results Compared with the CKD without anemia group,the serum iPTH,hs-CRP and duration of dialysis in the CKD anemia group were obviously increased,while the levels of ALB and A∕G were obviously decreased(P<0.05).Compared with the mild group,the serum iPTH and hs-CRP levels in the moderate and severe groups were obviously higher,but ALB and A∕G were obviously lower(P<0.05).Compared with the moderate group,the serum iPTH and hs-CRP levels in the severe group were obviously higher,but ALB and A∕G were obviously lower(P<0.05).Pearson analysis showed that iPTH and hs-CRP in serum were negatively correlated with Hb,while ALB and A∕G levels were positively correlated with Hb.Serum iPTH,ALB,hs-CRP and A∕G levels and duration of dialysis were influencing factors for CKD complicated with renal anemia.The area under the curve of serum iPTH,ALB,hs-CRP,and A∕G levels in the diagnosis of CKD complicated with renal anemia was 0.774,0.749,0.715,and 0.737,respectively,the sensitivity was 60.98%,87.80%,72.36%,and 86.99%,respectively,and the specificity was 88.62%,52.03%,62.60%,and 56.91%,respectively;the area under the curve,sensitivity and specificity of the combination of the four markers for predicting CKD complicated with renal anemia were 0.867,78.05%and 92.68%,respectively.Conclusion The levels of serum iPTH,hs-CRP,ALB,and A∕G are correlated with the degree of anemia in CKD patients,and the combined detection of the four has certain predictive value for CKD complicated with renal anemia.