晨尿尿蛋白／尿肌酐比值与24小时尿蛋白定量相关性分析

尿蛋白持续增多是肾脏损害的标志,24h尿蛋白定量测定是长期以来的“金指标”,但常常存在收集尿液繁杂、定时和定量不准确、部分尿样丢失、膀胱排空不完全、患者依从性差等问题,影响结果的准确性。为纠正此缺陷,美国肾脏病基金会改善肾脏疾病预后和生存质量的指南（NKFK／DOQI）推荐了尿蛋白／尿肌酐比值法。     

CKD 3期患者随机尿蛋白/尿肌酐比值与24h尿蛋白定量的相关性分析

目的：分析随机尿蛋白/尿肌酐比值与24 h尿蛋白定量的相关性,探讨随机尿蛋白/尿肌酐比值是否可以替代24 h尿蛋白定量,检测尿蛋白的排泄情况。方法：对184例慢性肾脏病（CKD）3期患者同时留取随机尿和24 h尿液标本,分别进行随机尿蛋白,尿肌酐与24 h尿蛋白定量测定,计算随机尿蛋白/尿肌酐比值,与24 h尿蛋白定量结果进行相关性分析。应用ROC曲线分析24 h尿蛋白定量≥1.0 g和≥0.15 g时与随机尿蛋白/尿肌酐比值间的相对应关系。结果：随机尿蛋白/尿肌酐比值与24 h尿蛋白定量呈良好正相关（r=0.771,P〈0.001）。应用ROC曲线分析随机尿蛋白/尿肌酐比值相应24 h尿蛋白定量1.00 g及0.15 g的诊断界点分别为0.83 g/gcr及0.16 g/gcr时敏感性与特异性最佳。结论：随机尿蛋白/尿肌酐比值可以反映CKD3期患者的尿蛋白排泄量,可替代24 h尿蛋白定量。     

慢性肾脏病患者尿蛋白肌酐比与24小时尿蛋白定量的相关性研究

目的探讨晨尿、随机尿的尿蛋白肌酐比值(protein/creatinine ratio,PCR)与24 h尿总蛋白定量(24-hour urine total protein quantity,24 hUTP)之间的相关性及其预测方程。方法选取在武汉市第一医院肾内科就诊的慢性肾脏病(CKD)患者211例,对患者晨尿PCR、随机尿PCR与24 hUTP进行差异性及相关性分析。采用ROC曲线分析晨尿PCR、随机尿PCR预测24 hUTP的最佳临界点。采用多元线性回归方法建立晨尿PCR、随机尿PCR预测24 hUTP的方程。结果晨尿PCR、随机尿PCR与24 hUTP之间无明显差异(P=0.81);晨尿PCR与24 hUTP间存在显著正相关(r=0.90,P0.01),随机尿PCR与24 hUTP间存在显著正相关(r=0.95,P均0.01),随机尿PCR与24 hUTP间的相关性高于晨尿。从性别、年龄、24 h尿量、病因、eGFR、Alb、总胆固醇水平方面对纳入患者进行分组,不同分组的晨尿PCR、随机尿PCR与24 hUTP间均存在显著正相关,且不同分组的随机尿PCR与24 hUTP的相关性均高于晨尿PCR。ROC曲线分析结果显示,以0.5 g、1.0 g、3.5 g作为24 hUTP的界点时,晨尿PCR预测24 hUTP的最佳临界值分别为0.70 g/g(敏感性84.4%,特异性86.0%)、1.09 g/g(敏感性95.8%,特异性91.3)、3.81 g/g(敏感性66.7%,特异性89.9%);随机尿PCR预测24 hUTP的最佳临界值分别为0.56 g/g(敏感性93.5%,特异性75.4%)、1.11 g/g(敏感性98.3%,特异性92.4%)、3.43 g/g(敏感性87.9%,特异性89.9%)。晨尿PCR、随机尿PCR预测24 hUTP的方程分别为:①24 hUTP(g)=0.793+0.793×晨尿PCR+0.124×总胆固醇-0.177×Alb(决定系数R~2=0.87);②24 hUTP(g)=0.369+0.856×随机尿PCR+0.132×总胆固醇-0.092×Alb(决定系数R~2=0.92),随机尿的预测方程比晨尿更准确。结论晨尿PCR、随机尿PCR与24 hUTP均有良好的相关性,其相关性不受性别、年龄、24 h尿量、病因、eGFR、Alb、总胆固醇水平的影响,且随机尿PCR与24 hUTP间的相关性高于晨尿PCR。应用预测方程,可有效的评估CKD患者的预后及诊疗效果,建议使用随机尿PCR预测方程代替24 hUTP检测。     

尿蛋白与尿肌酐比值的测定

尿蛋白持续增多是慢性肾损伤的重要标志。尿蛋白的检测为发现多种肾脏病早期到进展阶段提供了一个敏感的指标,对慢性肾脏病（CKD）治疗和判断预后具有重要意义。本文介绍了尿蛋白检测的4种方法,对比了各种尿蛋白检测的优缺点和临床意义以及大致对应关系,强调尿蛋白与尿肌酐比值检测的重要性。     

点时间尿蛋白与尿肌酐比值检测的临床应用评价

目的研究晨尿和随意尿的尿蛋白/尿肌酐(P/C)是否可以替代24h尿蛋白定量,用于监测尿蛋白的排出情况。方法选取本科住院患者68例共116份标本,对其晨尿P/C及随意尿P/C与24h尿蛋白定量进行相关分析。采用ROC曲线分析确定晨尿P/C相对于24h尿蛋白定量为1g及3g的诊断界点。再选取门诊肾脏病患者22例,研究活动对尿P/C检测的影响。结果住院患者晨尿P/C(及随意尿P/C)与24h尿蛋白定量中度相关。按肾功能分组的进一步分析显示,Ccr≤10ml/min时两者不相关,Ccr>10ml/min时高度相关。应用ROC曲线计算晨尿P/C相应24h尿蛋白定量1g及3g的诊断界点分别为0.94g/gcr及2.84g/gcr时敏感性和特异性最佳。晨尿P/C与随意尿P/C之间具有高度相关性。门诊患者随意尿P/C明显高于晨尿P/C。结论监测尿蛋白排出情况时,Ccr>10ml/min的患者点时间尿P/C可以替代24h尿蛋白定量,门诊患者以晨尿P/C为最佳。     

随机尿样的蛋白/肌酐比值预测显著蛋白尿的意义

蛋白尿被认为是心血管和肾脏病独立的危险因素,也是终末器官损害的预测因子.临床工作中常用24 h尿蛋白定量来评价患者的蛋白尿水平,但是这种方法由于影响因素众多而被普遍认为不可靠.     

尿蛋白测定方法与IgA肾病进展的相关研究

目的探讨IgA肾病患者尿蛋白肌酐比、尿白蛋白肌酐比、24 h尿蛋白定量之间的关系,并分别评估三者和IgA肾病临床及病理的关系,从而预测IgA肾病的进展。方法收集2017年5月至2018年4月在安徽医科大学第一附属医院行肾脏活检确诊为IgA肾病的患者资料,记录患者尿蛋白肌酐比、尿白蛋白肌酐比、24 h尿蛋白定量、肾小球滤过率、血压、牛津分型等指标,研究尿蛋白肌酐比、尿白蛋白肌酐比和24 h尿蛋白定量三者之间的关系,并探讨三者和血压、肾小球滤过率、牛津分型等之间的关系。结果 IgA肾病患者的尿蛋白肌酐比、尿白蛋白肌酐比、24 h尿蛋白定量三者存在密切相关性,其中尿蛋白肌酐比和尿白蛋白肌酐比具有最高的相关性(r_s=0.929,P0.01),尿蛋白肌酐比、尿白蛋白肌酐比、24 h尿蛋白定量均和肾小球滤过率、牛津分型T、C存在明显相关性(P0.05)。而有无高血压,牛津分型M、E、S和以上三者之间的关系无统计学差异(P0.05)。结论 IgA肾病患者的尿蛋白肌酐比、尿白蛋白肌酐比和24 h尿蛋白定量之间密切相关,三者和肾小球滤过率、牛津分型T、C均存在明显相关性。     

中国汉族人以尿白蛋白肌酐比值诊断微量白蛋白尿的界值研究

目的 探讨中国汉族人群以晨尿白蛋白肌酐比值（ACR）诊断微量白蛋白尿（MA）的界值。 方法 本研究对象来自于北京平谷区代谢综合征肾损害流行病学调查,随机整群抽取的部分受试者除外脓尿或者镜下血尿后自愿留取8 h过夜尿。以8 h尿白蛋白排泄率（UAE）作为诊断标准,应用受试者工作特征曲线（ROC）方法确定MA的诊断界值。 结果 （1）共1056人（男性494人、女性562人,年龄20~75岁）纳入本研究,MA的患病率为12.5%,临床蛋白尿患病率为1.7%。（2）ROC确定诊断MA的ACR下界值：男性1.95 g/mol（敏感性97.6%,特异性88.6%）,女性3.62 g/mol（敏感性83.8%,特异性89.1%）,总体受试者ACR下界值为2.78 g/mol（敏感性88.7%,特异性86.0%）;上界值：总体受试者ACR上界值为22.59 g/mol（敏感性100.0%,特异性98.8%）。（3）与8 h尿UAE诊断MA的一致性检验显示本研究按性别区分的诊断界值敏感性91.3%,特异性88.2%,阳性及阴性似然比为7.96和0.10,阳性及阴性预测值为56.9%和98.4%。 结论 晨尿诊断MA的ACR下界值存在性别差异,男性1.95 g/mol,女性3.62 g/mol,较目前国际推荐的性别特异性ACR诊断值偏高,具有良好的诊断性。     

糖尿病肾病患者尿FDP/尿蛋白比值检测的临床意义

目的 :探讨尿FDP/尿蛋白比值 (uFDP/uP)在糖尿病肾病 (DN)的临床意义。方法 :2型糖尿病、DN患者 4 5例。其中每月 1次随访 1年 ,uFDP/uP <0 .5 (L组 ) 10例 ;uFDP/uP >1.0 (H组 ) 13例。酶联免疫吸附法检测凝血、纤溶指标 ,并检测尿蛋白、肾功能变化。结果 :DN患者的uFDP/uP与凝血、纤溶活性及HbA1C、尿蛋白呈明显正相关 ,与肾功能呈明显负相关 ;与L组相比 ,H组患者存在明显凝血和纤溶活性增强 ,且肾功能恶化速度明显加快。结论 :DN患者的uFDP/uP不仅能反映其凝血、纤溶状态 ,而且还能反映DN的进展程度 ,预测肾功能恶化速度。     

Estimation of 24-hour urine protein quantity by the morning-urine protein/creatinine ratio

Background Many reports have described a correlation between the morning-urine protein /creatinine ratio (morning urine P/Cr) and the quantity of 24-h urine protein (Up), as well as regression formulas for Up with morning-urine P/Cr. However, there is no universal regression formula that can be used at all facilities. It is still controversial whether a qualitative calculation is required at outpatient clinics. To develop a practical and universal method, we used receiver operating characteristic (ROC) analysis to estimate Up from morning-urine P/Cr. Methods The subjects were 34 children (309 specimens) with kidney disease who had been admitted to Miyazaki Prefectural Hospital. We examined the correlations of P/Cr with Up and Up/body surface area (Up/BSA) using morning and daytime urine. We determined the cutoff values to estimate Up/BSA from morning-urine P/Cr with an ROC analysis. Next, we applied the values to specimens obtained from other facilities to show the universality of this approach. Results Up/BSA for samples in one hospital was significantly correlated with morning-urine P/C. When the morning-urine P/Cr ratio is ≧1.0 or ≧2.0, the Up/BSA ratio will exceed 0.5 or 1.0 (g/m² per day), respectively, and the efficiency was sufficiently high (efficiency for Up/BSA of ≧0.5: 88.0%, efficiency for Up/BSA of ≧1.0: 90.9%). When we analyzed samples from two other facilities with these cutoff values, both the sensitivity and specificity were greater than 80% for both facilities. Conclusions The use of cutoff values of 1.0 and 2.0 for morning-urine P/Cr determined by ROC analysis could be a universal method for quantitatively estimating Up/BSA ≧0.5 and 1.0, respectively.     

Correlation between 24-hour urinary protein excretion and protein/creatinine ratio in the first voided morning urine samples

To collect 24-hour urine of infants and young children is so difficult that 24-hour urinary protein excretion (24 H-UP) has been estimated from single voided urine samples. We investigated the correlation between 24 H-UP and the protein/creatinine ratio of the first voided morning urine samples (MUP/Cr) and evaluated the problems associated with this method. Six hundred and thirty-nine specimens, pairs of morning spot urine and 24-hour collected urine, were collected from 158 patients, aged 3 to 28, who were being followed at Kyoto City Hospital. The study population was divided into different subgroups by age, disease category and inpatient or outpatient status and linear regression analysis was performed for every subgroup. Although MUP/Cr correlated well with 24 H-UP, it was necessary to revise the estimation of 24 H-UP from MUP/Cr, which is lower in infants and young children because of age-related differences in creatinine excretion. If the patient's age is younger, the creatinine excretion rate is lower. The difference in 24 H-UP estimated from MUP/Cr was significant between inpatients and outpatients, with the estimated value being higher in outpatients than inpatients. The estimated value was also different according to disease category. We speculated that the difference in estimated 24 H-UP was affected by different rate of creatinine excretion related to age and other factors.     

晨尿蛋白/尿肌酐比值评估CKD患者尿蛋白排泄临床应用评价

目的 探讨晨尿蛋白/尿肌酐比值评估CKD患者尿蛋白排泄的临床价值.方法 选取住院慢性肾脏病患者136例,检测晨尿蛋白/尿肌酐和24h尿蛋白定量并进行相关性分析;分析GFR、性别、年龄、体重指数对二者相关性的影响,绘制ROC曲线分析确定晨尿蛋白/尿肌酐比值相对于24h尿蛋白定量≥0.15g,24h尿蛋白定量≥1.00g和24h尿蛋白定量≥3.00g的最佳诊断点.结果 晨尿蛋白/尿肌酐比值与24h尿蛋白定量呈显著正相关(r=0.83;P ＜0.001);GFR、性别、年龄、体重指数对二者的相关性没有影响;24h尿蛋白定量≥0.15g,24h尿蛋白定量≥1.00g和24h尿蛋白定量≥3.00g时,临床诊断敏感性和特异性最佳点分别为晨尿蛋白/尿肌酐比值≥0.20g/gcr,晨尿蛋白/尿肌酐比值≥0.95 g/gcr和晨尿蛋白/尿肌酐比值≥2.92g/gcr.结论 晨尿蛋白/尿肌酐比值可替代24h尿蛋白定量,监测肾脏病患者尿蛋白排泄情况.     

Cost-benefit analysis and prediction of 24-hour proteinuria from the spot urine protein-creatinine ratio.

AIM: A prospective cross-sectional study was performed on 170 patients with various glomerular diseases to study the accuracy of predicting 24-hour proteinuria from the spot urine protein-creatinine ratio (Up/Uc). A cost-benefit analysis was performed for the New Zealand health economic system to obtain the best cut-off values for proteinuria. SUBJECTS, METHODS AND RESULTS: Two spot urine samples (Up/Uc1 and Up/Uc2) were collected on the same day as the collection of a 24-hour urine. A randomly chosen subsample of 50 patients provided a second set of urine samples. The correlation and precision of agreement between the two methods were examined. The predictive intervals were calculated for derived 24-hour proteinuria. The level of agreement was evaluated by the Bland-Altman method and concordance analysis. The limits of agreement were evaluated against the clinical limits of agreement. A cost-benefit analysis (CBA) was performed to obtain the optimum operating points on receiver operating characteristic (ROC) curves for the best decision threshold. Correlations of r = 0.97 and 0.99 were observed between Up/Uc1, Up/Uc2 and 24-hour proteinuria, respectively. The 95% predictive intervals were wide. A high concordance correlation coefficient was obtained. The most of the differences between the two methods fell within the clinical limits of agreement. The Up/Uc1 of 0.26 and 3.20 represent the best thresholds to detect normal and nephrotic proteinuria, respectively. CONCLUSIONS: Despite wide confidence intervals, a good correlation and precision of agreement were demonstrated between the two methods across the whole range of proteinuria, regardless of the level of renal function. The difference between the two methods was less than the biological variability in the protein excretion and its measurement, enabling the methods to be used interchangeably. The optimum thresholds for abnormal and nephrotic range proteinuria were obtained.     

The repeatability of the 24-hour pad test

A prospective observational study was conducted in a tertiary urogynaecology unit in women with the primary symptom of urinary incontinence to assess the repeatability of the 24-hour pad test. One hundred and eight women undertook seven 24-hour pad tests over 7 consecutive days together with 7 simultaneous fluid and activity charts. The results were analysed collectively and according to urodynamic subsets. Repeatability was assessed by repeated measures analysis of variance and univariate analysis of variance for each urodynamic diagnosis group (USI, mixed and no USI). Variation between pad test weights over the 7 days was low, supporting good repeatability. The number of days of pad testing required to approximate the 7-day average was 3 days. However, a single 24-hour pad test correlated highly with the 7-day average (r=0.881) and was considered sufficient to gauge leakage severity.     

活性维生素D与24h尿钙相关性研究

目的 对连续服用活性维生素D 6个月与不定期服用该药治疗骨质疏松患者,测24 h尿钙定量并比较.方法 47例骨质疏松患者连续服用维生素D 6个月为治疗组,37例间断服用活性维生素D 6个月为对照组.美国RUNAR双能X线骨密度仪测定骨密度;美国强生VIPROS 250仪器干化学法测24 h尿钙定量;德国罗氏MODULAR PPISE 900仪器酶速率法测定血液生化指标.结果 治疗组与对照组相比较,差异无显著性(P>0.05).结论 肝肾功能正常的骨质疏松患者,生理剂量内活性维生素D连续服用6个月,对机体是安全的.     

The urine protein to creatinine ratio (P/C) as a predictor of 24-hour urine protein excretion in renal transplant patients.

BACKGROUND: The purpose of this study was to examine the utility of the random urine protein to creatinine ratio (P/C) in evaluation and longitudinal management of proteinuria in adult renal transplant recipients with or without overt nephropathy in an outpatient clinic. METHODS: A total of 289 adult renal transplant recipients provided 24-hr urine collections for total protein and creatinine, followed by a random urine for protein and creatinine. For longitudinal analysis, 192 of these patients provided two 24-hr urine collections with concomitant random urine specimens separated on average by 6.8 months. As well, 134 patients provided a total of 851 multiple-paired spot and 24-hr urine samples (range 2 to 12) over a 2-year period. RESULTS: The log random urine P/C ratio correlated significantly to the log 24 UP (r=0.749, P<0.0001) with or without nephrotic range proteinuria. High sensitivity (74.4-90%) and specificity values (93-98%) were found for estimating proteinuria from 0.5 to 2 g/day. However, the precision of estimation decreased as the level of urinary protein excretion increased to >3 g/day. The positive predictive value decreased as proteinuria became >3 g/day, perhaps because of the low prevalence of patients with high level proteinuria in our sample. The direction of change in P/C ratio longitudinally was accompanied by a similar direction of change in 24 UP, which was highly significant (r=0.7555, P<0.0001). CONCLUSION: We conclude that the urine P/C ratio is a useful and convenient screening and longitudinal test for proteinuria.     

Simplified quantification of urinary protein excretion using a novel dipstick in children

Although the quantification of protein excretion is valuable for diagnosing and monitoring renal disease, accurate, timed, urine collection entails practical difficulties in children. Several authors have shown that the random urine protein/creatinine ratio (UP/UC) correlates well with timed protein excretion. A novel dipstick, Multistix PRO, has recently enabled us to analyze concentrations of both urinary protein and creatinine, semi-quantitatively, in 60 s. The aim of this study was to investigate whether the UP/UC values obtained by Multistix PRO correlate well with those obtained by quantitative methods and daily urinary protein excretion. In order to obtain the UP/UC values, we measured urinary protein and creatinine concentrations both semi-quantitatively by Multistix PRO and quantitatively by conventional methods. The relationship between the semi-quantitative UP/UC by Multistix PRO and the quantitative UP/UC by conventional methods was analyzed. Similarly, the relationship between the semi-quantitative UP/UC and daily urinary protein excretion was studied. Semi-quantitative UP/UC by Multistix PRO correlated closely with both quantitative UP/UC and daily urinary protein excretion (r=0.86 and r=0.91, respectively). A cut-off level of heavy proteinuria, i.e., nephrotic range of proteinuria (>3.5 g/day) corresponded to 3.0, assessed by UP/UC by Multistix PRO. The semi-quantitative UP/UC by Multistix PRO correlated well with both quantitative UP/UC and daily urinary protein excretion, and use of the Multistix PRO would avoid errors and difficulties associated with timed urine collection. It is, therefore, a useful tool to monitor the urinary protein excretion in children with renal diseases at outpatient clinic.     

食管动力学及24小时食管pH监测在胸痛诊断中的意义

目的探讨食管动力学、24小时食管pH及24小时动态心电图监测对反复发作性胸痛的诊断价值. 方法对46例反复发作胸痛的患者进行食管动力学检测、24小时食管pH及24小时动态心电图监测,根据检查结果,给予相应治疗,并观察近期效果.结果 46例患者中发现非特异性食管功能障碍24例,其中伴有胃食管反流14例、心肌缺血4例;贲门失弛缓症5例,其中伴有胃食管反流1例;弥漫性食管痉挛4例,其中伴有胃食管反流4例、心肌缺血2例;胡桃夹食管(nutcracker esophagus)1例.结论对反复发作性胸痛患者联合食管测压、24小时食管pH和24小时动态心电图监测有助于食管源性及心源性胸痛的诊断,而且对其鉴别诊断亦有帮助.