尿蛋白/尿肌酐比值评估IgA肾病病情变化的意义

The significance of urine albumin-to-creatinine ratio in assessment of status of disease in IgA nephropathy

目的:分析尿蛋白/尿肌酐比值与24h尿蛋白定量间的关系,探讨该比值评估原发性IgA肾病病情变化的临床意义。方法:以2014年1月~2015年5月本院收治的102例IgA肾病为研究对象,其中44例进行了为期1年的随访并取得完整的随访资料,收集患者住院期间和随访期间一般资料和尿蛋白/尿肌酐比值(ACR)、24h尿蛋白定量(UTP)等临床生化指标,分析ACR与UTP的关系,并探讨该比值评估原发性IgA肾病病情变化的临床意义。结果:随着CKD分期的增加,患者血肌酐、尿酸、胱抑素C、ACR、UTP、平均动脉压(MAP)、钾、磷水平则越高,其差异均具有统计学意义;eGFR、血红蛋白则越低,其差异均具有统计学意义。Oxford分类中S、E和T评分差异具有统计学意义。44例随访患者中有6例存在肾脏功能临床进展,所有患者ACR与UTP之间呈正相关(r=0.799,P=0.000)。ROC曲线分析,预测UTP值≥0.15g/24h、0.30g/24h和1.0g/24h的ACR判别值分别为125.15mg/g、154.44mg/g和760.31mg/g,相应的AUC值为0.84、0.84和0.90。CCA模型显示从尿蛋白入手,ACR相关系数为+0.7440,高于UTP相关系数+0.3224。经单变量分析ACR(OR5.57,95%CI0.80-421.80,P=0.032)和UTP(OR9.62,95%CI0.89-472.40,P=0.023)为eGFR下降的危险因素。结论:尿蛋白/尿肌酐比值较24h尿蛋白定量更可靠地反映原发性IgA肾病病情变化,对临床控制病情具有重要的指导意义。

Objective To investigate the correlation between albumin-to-creatinine ratio in the urine and 24-hour urine proteinuria and to explore this ratio to assess the status of disease in IgA nephropathy. Methods 102 cases of IgA nephropathy were collected from January 2014 to May 2015 in our hospital, of which 44 cases had a 1-year follow-up and get the complete follow-up data. general information and urine protein / urine creatinine ratio (ACR), 24 h urinary protein (UTP) and other clini-cal and biochemical indicators were collected during hospitalization and during follow-up, investigate the correlation between ACR and UTP and to explore this ratio to assess the status of disease in IgA nephropathy. Results With the increase in CKD stage, the higher with the serum creatinine, uric acid, cystatin C, ACR, UTP, mean arterial pressure (MAP), potassium, phos-phorus levels, and the differences were statistically significant, the lower with the eGFR, the hemoglobin, the differences were statistically significant. Oxford classification S, E and T score difference were statistically significant. Clinical progression was observed in 6 patients of 44 follow-up patients, A strong correlation was found between ACR and UTP measurements. Using the ROC curves, ACR discriminant values of 125.15,154.44 and 760.31 mg/g reliably predicted UTP values of≥0.15,0.3 and 1.0 g/24 h, respectively. The corresponding AUC values were 0.84, 0.84 and 0.90.CCA model showed For the proteinuria set, the ACR correlation coefficient (+0.7440) was higher than the UTP correlation coefficient (+0.3224). Univariate analyses iden-tified both the ACR (OR 8.57, 95%CI 0.80-421.80, P=0.0326) and UTP (OR 9.62, 95% CI 0.89-472.40, P=0.0229) as risk factors for eGFR decline. Conclusion The albumin-to-creatinine ratio compared with 24h urinary protein more reliably reflect changes in status of IgA nephropathy,which has important significance for clinical control of the disease.