慢性肾脏疾病患者人附睾蛋白4和CYFRA21-1水平的变化及临床诊断价值

目的探讨人附睾蛋白4(HE4)和细胞角蛋白19片段(CYFRA21-1)在慢性肾脏疾病(CKD)女性患者血清中的表达水平及临床诊断价值。方法选取140例慢性肾脏疾病(CKD)女性患者为研究组,34例健康者作为对照组,分别使用电化学发光法、苦味酸法、颗粒增强免疫投射比浊法和胶乳免疫比浊法检测血清HE4、CYFRA21-1、肌酐(Cr)、胱抑素C(Cystatin C)和β2微球蛋白(β2-MG)在不同CKD分期中水平变化;对CKD各期患者的HE4、CYFRA21-1与估算的肾小球滤过率(eGFR)进行相关性分析;应用ROC曲线对其临床诊断价值进行评价。结果 CKD各期患者HE4和CYFRA 21-1水平均明显高于对照组(P0.01);血清HE4水平与eGFR呈负相关(r=-0.851,P0.05),血清CYFRA21-1水平与eGFR无明显相关性(r=-0.387,P0.05);应用ROC曲线分析各指标,HE4、CYFRA21-1、Cr、Cystatin C和β2-MG曲线下的面积分别为:0.931、0.862、0.930、0.974和0.949,诊断敏感度由高至低依次为:Cystatin C、β2-MG、HE4、Cr、CYFRA21-1。结论 CKD女性患者HE4和CYFRA21-1水平明显升高,且具有诊断意义。

Diagnosis value of human epididymis protein 4 and CYFRA21-1 in the patients with chronic kidney disease

Objective To study the diagnosis value of the human epididymis protein 4(HE4) and CYFRA21‐1 in female patients with chronic kidney disease (CKD) .Methods A total of 140 patients with CKD were selected as case group and 34 healthy people were selected as control group .By the method of electrochemiluminescence ,Jaffe‐compensated assay ,particle‐enhanced turbidimetric immunoassay and latex enhanced immune turbidimetry ,serum level of HE4 ,CYFRA21‐1 ,creatinine (Cr) ,cystatin C and β2‐micro‐globulin (β2‐MG) in CKD patients were detected ,and the correlation of HE4 ,CYFRA21‐1 and estimated glomerular filtrate rate (eGFR) were also analyzed .Receivers operating characteristic (ROC) curve analysis were performed to determine the clinical diag‐nostic value .Results The serum level of HE4 and CYFRA21‐1 in different stages of CKD patients was significantly higher than that of healthy control group(P<0 .01) .Pearson correlation analysis showed the negative correlation between HE 4 and eGFR(r=-0 .851 ,P<0 .05) ,while CYFRA 21‐1 were not correlated with eGFR (r= -0 .387 ,P>0 .05) .The ROC analysis showed that the area under the curve was 0 .931 ,0 .862 ,0 .930 ,0 .974 and 0 .949 ,respectively .Their sensitivities were diagnosed as following :Cysta‐tin C>β2‐MG> HE4>SCR>CYFRA21‐1 .Conclusion Compared with healthy people ,the levels of HE4 and CYFRA21‐1 in fe‐male patients with CKD increase obviously ,which could have important diagnostic values .