探讨晨尿蛋白／肌酐比值的诊断界值及临床应用

目的通过调查健康人群和肾病患者晨尿蛋白／肌酐比值，以及肾病患者24小时尿蛋白定量，界定晨尿蛋白／肌酐比值的正常、病理诊断临界值。方法选取临床确诊的住院及门诊肾脏病患者129例，留取其晨尿、24小时尿两份标本，同时进行尿蛋白，尿肌酐的测定，计算晨尿蛋白／肌酐比值，将比值与24小时尿蛋白结果进行相关性分析；同时用受试者工作曲线（receiver operating characteristics，ROc）曲线探讨肾病患者相对于24小时尿蛋白定量，轻度蛋白尿〈1．0g／d，重度蛋白尿〉3．0g／d时，晨尿蛋白／尿肌酐相对应的最佳诊断界点。留取门诊健康人群尿常规检查及镜检结果全阴性，询问无现病史的晨尿标本211人份，测定晨尿蛋白／肌酐比值，相对于129例肾病患者的晨尿蛋白／肌酐比值，用ROC曲线探讨晨尿蛋白／肌酐比值的病理最佳诊断界点。结果晨尿蛋白／肌酐比值与24小时尿蛋白呈显著正相关（r=0．892，P〈0．01）；24小时尿蛋白定量轻度蛋白尿〈1．0g／d，重度蛋白尿〉3．0g／d，晨尿蛋白／尿肌酐（UCr）相对应的最佳诊断界点为〈0．90g／g（敏感度96．2％，特异度86．2％）、〉2．88g／g（敏感度82．9％，特异度85．6％）；无现病史的晨尿标本尿蛋白／尿肌酐比值，相对于肾病患者的晨尿蛋白／肌酐比值，ROC曲线最佳诊断界点为0．23g／g（敏感度82．9％，特异度86．0％）。结论晨尿蛋白／肌酐比值诊断界点可替代24小时尿蛋白定量的检测。

Survey on diagnosis critical value of protein-creatinine ratio in morning urine and clinical application

Objective By survey on the protein/creatinine ratio in morning urine in healthy people and patients with kidney diseases and by measuring 24 hour urine protein,the authors deduced the critical value of morning urinary protein/creatinine ratio of normal and pathological diagnosis. Methods There were 129 in- and out-patients with kidney diseases and 211 healthy people in the study. Their first morning and 24 hour urine specimens were collected; urine protein and urine creatinine were examined;morning urinary protein/creatinine ratio was calculated;the correlation was analyzed between morning urinary protein/creatinine ratio and 24 hour urine protein. Using ROC curve, the critical values of morning urinary protein/creatinine ratio of normal and pathological diagnosis in kidney diseases were explored. Results There was a marked positive relation between morning urinary protein/creatinine ratio and 24 hour urine protein（ r = 0. 892, P 〈 0.01）;the critical value was 〈 0.90 g/g and 〉 2.88 g/g with the urine protein concentration of 〈1.0 g/d （the sensitivity was 96.2%;the specificity was 86.2%） and 〉 3.0 g/d （the sensitivity 82.9 % ;the specificity 85.6 % ）, respectively; the healthy people had a critical value of 0.23 g/g （the sensitivity 82.9 % ; the specificity 86.0%）. Conclusion The critical value of morning urinary protein/creatinine ratio can replace 24 hour urine protein in diagnosis of kidney diseases.