检验医学与临床2017，Vol.14Issue(2)：193-197,5.DOI:10.3969/j.issn.1672-9455.2017.02.015
尿清蛋白／肌酐比值在筛查糖尿病肾病中的应用价值
The advantage of urinary albumin to creatinine ratio on screening diabetic kidney disease
摘要
Abstract
Objective To evaluate the diagnostic values of urinary albumin to creatinine ratio (UACR) in a random spot urine collection for screening diabetic kidney disease (DKD) .Methods All 1 083 patients with type‐2 diabetes mellitus from October 2015 to April 2016 in hospital were selected ,in which the patients with DKD were 390 cases ,whose urine and serum specimen were collected simultaneously to detect urinary albumin (UAlb) ,urinary creatinine (UCr) ,serum creatinine (SCr) ,and serum Cystatin C (CysC) .Thus their UACR and eGFRs (eGFRCr ,eGFRCysC ,eGFRCysC/Cr and eGFRCH ) from three CKD‐EPI equations and a CysC‐e‐quation applicable to the Chinese populations were obtained .Then ,their relationships between UACR into groups to eGFRs into stages were compared in patients with DKD ,and their diagnostic values of screening DKD were analyzed by ROC curve and Logistic regression .Results The UACR level of DKD patients was significantly higher ,and eGFR levels of each CKD‐EPI equation were significantly lower ,when compared with non‐DKD patients ,the difference was statistically significant (P<0 .001) ,but the degree between increasing UACR with declining eGFRs had no accordance ,except eGFRCH (P=0 .005) .The DKD screening performance of UACR was higher than UAlb and each eGFRs (AUC= 0 .957 vs .0 .729 -0 .912) ,with statistical significant difference (P<0 .001) .The screening sensitivity and specificity of UACR were 89 .0% and 100 .0% ,with statistic significance for each eGFR (P<0 .05) ,which were 43 .1% to 55 .6% and 82 .5% to 96 .4% .When combinative detection of UACR and eGFRs ,the AUC was in‐creased to 0 .972 -0 .980 ,which had statistical differences than UACR detected alone (P< 0 .05) .There were 43 ,cases missed screening by UACR ,which were detected 34 ,28 ,30 and 23 cases by eGFRCr ,eGFRCysC ,or eGFRCysC/Cr ,eGFRCH respectively .By the two standards of maximum diagnostic performance and minimum cost for threshold determination ,the judging thresholds of alone CysC‐based eGFR was difference .Conclusion UACR should be used routinely as the first target for screening DKD in clinical labo‐ratory .Combined detection of eGFR can reduce the leakage of UACR patients with normal DKD .关键词
糖尿病/糖尿病肾脏疾病/尿清蛋白/肌酐比值/肾小球滤过率Key words
diabetes/diabetic kidney disease/UACR/eGFR引用本文复制引用
陈小红,杨渝伟,黄玉霞,俸家富..尿清蛋白／肌酐比值在筛查糖尿病肾病中的应用价值[J].检验医学与临床,2017,14(2):193-197,5.基金项目
四川省科技厅支撑计划项目（2009SZ0066）；四川省卫生和计划生育委员会科研课题资助项目（150175）。 （）
