血清胱抑素C和尿微量白蛋白联合检测在人类免疫缺陷病毒感染者肾功能损伤检测中的应用价值

目的评估血肌酐和尿常规的常规检测基础上联合血清胱抑素C和尿微量白蛋白检测在人类免疫缺陷病毒（HIV）感染者肾功能损伤检测中的应用价值。 方法以2019年2～5月于首都医科大学附属北京地坛医院感染一科住院的169例HIV感染者为研究对象，完善其尿常规、尿微量白蛋白、血肌酐、血清胱抑素C检测；分析尿蛋白及尿微量白蛋白的阳性检出率及其差异，血肌酐升高及血清胱抑素C升高的比例及其差异。计算应用替诺福韦酯（TDF）及合并丙型肝炎、高血压、糖尿病、肿瘤的肾功能损伤的相对危险度。 结果169例HIV感染者中尿常规示尿蛋白阳性者5例（3.0%），尿微量白蛋白升高者17例（10.1%），两者阳性检出率差异具有统计学意义（χ² = 5.9、P = 0.007）。血肌酐升高者10例（5.9%），血清胱抑素C升高者20例（11.8%），两者阳性检出率差异具有统计学意义（χ² = 3.0、P = 0.042）。在尿常规和血肌酐检测的基础上联合检测尿微量白蛋白和血清胱抑素C的总体阳性检出率为49例（30.0%）。CD4⁺ T淋巴细胞计数< 200个/μl与≥ 200个/μl组患者血清胱抑素C水平分别为0.94（0.83，1.05）mg/L、0.85（0.77，0.95）mg/L，差异具有统计学意义（Z =-3.02、P = 0.003）。应用TDF及合并丙型肝炎、高血压、糖尿病、肿瘤的肾功能损伤的相对危险度分别为1.1、1.5、1.9、2.2和1.4。 结论HIV感染者中，单纯以尿常规为依据评估有无蛋白尿，以血肌酐水平为依据评估肾小球滤过功能会低估肾功能损伤的患病率。在常规检测血肌酐和尿常规的基础上联合检测血清胱抑素C和尿微量白蛋白在提高HIV感染者肾功能损伤检出率方面具有重要的应用价值。低CD4⁺ T淋巴细胞计数、应用TDF及合并丙型肝炎、高血压、糖尿病、肿瘤均为肾功能损伤的危险因素。

Value of combined detection of serum cystatin C and urinary microalbumin on detection of human immunodeficiency virus-infected patients with renal dysfunction

ObjectiveTo investigate the value of combined detection of serum cystatin C and urinary microalbumin on the basis of serum creatinine and routine urine detection in detection of renal dysfunction of patients with human immunodeficiency virus infection. MethodsTotal of 169 patients with HIV infection were collected in Division 1st, Department of Infection Diseases, Beijing Ditan Hospital, Capital Medical University from February to May 2019. The levels of urine routine, urine microalbumin, serum creatinine and serum cystatin C of the patients were detected, respectively. The positive rates of urine protein and urine microalbumin and their difference, the proportion of serum creatinine elevated and serum cystatin C elevated and their difference were analyzed. The relative risks of renal function injury with tenofovir disoprox (TDF) application and complicated with hepatitis C, hypertension, diabetes and tumor were calculated, respectively. ResultsAmong the 169 cases with HIV infection, 5 cases (3.0%) were with proteinuria and 17 cases (10.1%) with microalbuminuria, with significant difference (χ² = 5.9, P = 0.007). There were 10 cases (5.9%) with serum creatinine elevated and 20 cases (11.8%) with serum cystatin C increased, with significant difference (χ² = 3.0, P = 0.042). Serum creatinine increased in 10 cases (5.9%), while cystatin C increased in 20 cases (11.8%). Combined detection of urinary microalbumin and serum cystatin C base on urine routine and serum creatinine detection, the overall positive rate was 30.0% (49 cases). The median serum cystatin C were 0.94 (0.83, 1.05) mg/L and 0.85 (0.77, 0.95) mg/L of patients with CD4⁺ T < 200 cells/UL and patients with ≥ 200 cells/UL, respectively, with significant difference (Z =-3.02, P = 0.003). The relative risks of TDF application and complicated with hepatitis C, hypertension, diabetes and tumor were 1.1, 1.5, 1.9, 2.2 and 1.4, respectively. ConclusionsAmong HIV-infected patients, the incidence of renal dysfunction would be underestimated if only based on urine routine for proteinuria and serum creatinine for glomerular filtration rate. The combined detection of serum cystatin C and urinary microalbumin besides urine routine and serum creatinine was important in the detection of renal dysfunction in patients with HIV infection. Lower CD4⁺ T lymphocyte count, use of TDF and complicated with hepatitis C, hypertension, diabetes and tumor were risk factors for renal dysfunction.