联合生物标志物检测在慢性肾脏疾病中的临床研究

目的 探讨尿微量白蛋白（mALB）、尿β2-微球蛋白（β2-MG）、尿视黄醇结合蛋白（RBP）、尿转铁蛋白（TRF）、尿半胱氨酸蛋白酶抑制剂C（Cystatin C）及尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）在慢性肾脏疾病中的临床研究及诊断价值.方法 选择2012年8月～2013年1月在本院住院的慢性肾脏病患者121例为病例组,健康体检者60例为对照组.尿mALB、β2-MG、RBP、TRF及Cystatin C采用酶联免疫吸附法检测,尿NAG采用对硝基苯酚（PNP）比色法检测,并对两组检测结果进行比较及统计学分析,以受试者工作特征（ROC）曲线及曲线下面积（AUC）评价各项标志物单—及联合应用时在慢性肾脏疾病中的诊断价值.结果 病例组中121例患者的尿液生物标志物测定含量明显高于对照组.通过ROC曲线、诊断试验结果显示：病例组中尿mALb、TRF、Cystatin C、NAG、RBP及β2-MG的敏感性显著高于血肌酐（Scr）和血尿素氮（BUN）.尿mALb、TRF、Cystatin C、NAG、RBP及β2-MG的曲线下面积分别为：0.988、0.984、0.974、0.947、0.915、0.897,95％可信区间分别是0.973—1.000、0.963～1.000、0.956 ～0.992、0.910～0.984、0.877～0.954、0.851 ～0.944,联合这6种尿液标志物得到的曲线下面积为0.990,95％可信区间是0.976 ～0.998,差异具有统计学意义（P＜0.001）.结论 病例组中各项尿液标志物的敏感性明显高于Scr和BUN,可以作为慢性肾脏病的诊断标志物.尿nALb、TRF、Cystatin C及NAG的曲线下面积最大,尿RBP和β2-MG也显示了较好的诊断价值.联合应用尿液标志物可以更好地预测临床上急性和慢性肾脏损害的发生,对预防慢性肾脏病的发展具有重要的临床价值.

Clinical study on combined biomarker detection in chronic kidney disease

Objectives Explore the urine mALB,urine β2-MG,urine RBP,urine TRF,urine Cystatin C and urine NAG in chronic kidney disease in the clinical research and diagnostic value.Methods Choice in August 2012 to January 2013 in our department in hospital,121 cases of patients with chronic kidney disease （CKD）as the case group,60 cases of healthy check-up shall be considered as control group.urine mALB,β2-MG,RBP,TRF,and Cystatin C detected by enzyme-linked immunosorbent method,urine NAG of nitro phenol （PNP）colorimetric method is used to detect,and carries on the comparison to two groups of test results and statistical analysis,to the receiver-operating characteristic （ROC） curve and area under curve （AUC） in the evaluation of various markers of the single and joint application of diagnostic value in chronic kidney disease.Results Cases in 121 cases of the urine biomarkers determination content is significantly higher than the control group,by ROC curve,diagnostic test results showed that cases of urine mALb,TRF,Cystatin C,NAG,RBP,β2-MG the sensitivity significantly higher Scr and BUN.urine mALb,TRF,Cystatin C,NAG,RBP of β2-MG,area under curve are：0.988、0.984、0.974、0.947、0.915、0.897,95% confidence interval are respectively 0.973 ～ 1.000、0.963 ～ 1.000、0.956 ～ 0.992、0.910 ～ 0.984、0.877 ～ 0.954、0.851 ～ 0.944,Combined the six kinds of urine biomarkers of the area under the curve is 0.990,95% CI 0.976 0.998,the difference was statistically significant（P 〈0.001）.Conclusions The sensitivity of urine markers of the case group was obviously higher than that of Scr and BUN,and can be used as a diagnostic marker of chronic kidney disease.urine mALb,TRF,Cystatin C and NAG area under the curve of the largest,urine RBP and β2-MG also showed a good diagnostic value.Combined use of urine markers can better predict the clinical incidence of acute and chronic kidney damage,to prevent the development of chronic kidney disease has important clinical value.