慢性肾脏病患者血、尿视黄醇结合蛋白和血、尿胱抑素C的表达及其临床意义

Clinical significance of retinal binding protein and cystatin C in blood and urine of patients with chronic kidney disease

目的 探讨血、尿视黄醇结合蛋白(RBP)和血、尿胱抑素C(Cystatin C)在慢性肾脏疾病中的表达及意义.方法 选择2012年8月至2013年1月在我院住院的慢性肾脏病患者121例为病例组,健康体检者60名为对照组.均行血、尿RBP和血、尿Cystatin C检测.尿RBP、Cystatin C采用酶联免疫吸附法检测,血RBP、Cystatin C采用免疫比浊法检测,并对两组研究对象检测结果进行比较,以受试者工作特征(ROC)曲线及曲线下面积(AUC)评价各项指标在慢性肾脏疾病中的敏感性及临床意义.结果 病例组12例患者尿RBP、尿Cystatin C、血RBP及血Cystatin C的阳性率分别为89.6％、92.6％、52.5％、59.5％,明显高于对照组(对照组60名中尿RBP、Cystatin C及血RBP、Cystatin C的阳性率均为0)(P均＜0.001).通过ROC曲线、诊断试验结果显示:病例组中尿RBP、尿Cystatin C的敏感性显著高于血RBP及血Cystatin C.尿RBP、尿Cystatin C、血RBP及血Cystatin C的曲线下面积分别为:0.915、0.974、0.655、0.623,95％可信区间分别是0.877 ～0.954、0.956～0.992、0.575～0.736、0.543～0.702(P均＜0.001).结论 尿Cystatin C、尿RBP的敏感性显著高于血Cystatin C和血RBP,可以作为慢性肾脏病的诊断指标,为更好地预测急性和慢性肾脏损害的发生、发展提供重要的临床诊断依据.

Objective To investigate the clinical significance of retinal binding protein (RBP) and Cystatin C in blood and urine in patients with chronic kidney disease (CKD).Methods One hundred and twenty-one patients with CKD in Nephrology Laboratory of The People's Hospital of Xinjiang Uygur Autonomous Region from Aug.2012 to Jan.2013 were served as the case group.Sixty healthy check-up people were considered as control group.Enzyme linked immunosorbent assay was used to detect RBP and Cystatin C in urine,and the immune turbidimetry testing was applied to detect RBP and Cystatin C in blood.The receiveroperating characteristic (ROC) curve and area under curve (AUC) were applied to evaluate the sensibility and diagnostic value of indexes in CKD.Results The positive rate of RBP,Cystatin C in urine and blood were 89.6％,92.6％,52.5％,59.5％ respectively of 12 patients in case group,higher than those in control group (all value were 0,P ＜0.001).ROC curve showed that the sensitivity of urine RBP and Cystatin C were higher than that in blood of case group.AUC of RBP,Cystatin C level in urine and blood were 0.915,0.974,.655,and 0.623 respectively.And 95％ confidence interval were 0.877-0.954,0.956-0.992,0.575-0.736,0.543-0.702 respectively,and the differences are statistically significant (P ＜ 0.001).Conclusion The sensitivity of urine cystatin C and RBP are significantly higher than that in blood,which might be served as a diagnostic marker of CKD and can provide important basis for clinical diagnosis.