CRP 和 CysC 联合检测对痛风患者早期肾功能损伤的诊断价值研究

目的：探讨血清 C-反应蛋白（CRP）、胱抑素 C（CysC）联合检测对于早期诊断痛风患者的肾功能损伤的临床价值。方法对收治的151例痛风患者进行回顾性分析，根据患者肾小球滤过率（GFR）将患者分为肾功能损伤组（60 ml/ min ＜ GFR ＜90 ml/ min）59例和非损伤组（90 ml/ min≤GFR ＜90）92例，比较2组患者的 CRP、CysC、GFR、尿β2-微球蛋白（β2-MG）、尿微量白蛋白（mAlb）、尿酸（UA）水平的差异。结果肾功能损害组患者的 CRP、CysC、GFR、β2-MG、mAlb、UA、GFR 值与非损伤组患者比较，差异均具有统计学意义（ P ＜0.05）。CRP 诊断痛风患者肾损害的灵敏度＝62.71％、特异度＝84.78％、误诊率＝15.22％、漏诊率＝35.28％、阳性预测值＝72.55％、阴性预测值＝78％。CysC 诊断痛风患者肾损害的灵敏度＝57.63％、特异度＝77.17％、误诊率＝22.83％、漏诊率＝41.37％、阳性预测值＝61.82％、阴性预测值＝73.96％。CysC ＋ CRP 诊断痛风患者肾损害的灵敏度＝86.443％、特异度＝86.96％、误诊率＝13.04％、漏诊率＝13.55％、阳性预测值＝80.95％、阴性预测值＝90.91％，ROC 曲线下面积 AUC ＝0.908。结论痛风肾功能损伤患者的 CRP、CysC 均较非损伤患者升高显著，将二者结合起来作为早期肾功能损害诊断指标能够显著提高诊断价值。

The diagnostic value of combination dectection of CRP with Cys C for early renal function injury in patients with gout

Objective To investigate the diagnostic value of combination dectection of serum C reactive protein (CRP)with Cystatin C(Cys C)for early renal function injury in patients with gout. Methods The data of 151 patients with gout in our hospital from July 2011 to July 2014 were retrospectively analyzed. According to glomerular filtration rate(GFR), these patients were divided into renal injury group(60ml/ min < GFR < 90ml/ min)( n = 59)and non injury group (90ml/ min = GFR < 90)( n = 92),the differences of CRP,Cys C,GFR,β2-MG,urine microglobulin( β2-MG),urinary albumin(mAlb),uric acid(UA)were compared between two groups. Results There were significant differences in CRP, Cys C,GFR,β2-MG,mAlb,UA,GFR between renal injury group and non injury group( P < 0. 05). The diagnosis sensitivity by CRP was 62. 71% ,specificity 84. 78% ,misdiagnosis rate 15. 22% ,omission diagnose rate 35. 28% ,positive predictive value 78% ,negative predictive value 72. 55% ,and the diagnosis sensitivity by Cys C was 57. 63% ,specificity 77. 17% , misdiagnosis rate 22. 83% ,omission diagnose rate 41. 37% ,positive predictive value 61. 82% ,negative predictive value 73. 96% ,however,the diagnosis sensitivity by Cys C + CRP was 86. 44% ,specificity 86. 96% ,misdiagnosis rate 13. 04% , omission diagnose rate 13. 55% ,positive predictive value 80. 95% ,negative predictive value 90. 91% ,and the area under ROC curve of AUC was 0. 908. Conclusion The levels of CRP and Cys C in patients with gout complicated by renal function injury are obviously increased,thus the combinationn detection of CRP with Cys C can enhance the diagnostic value for early renal function injury in patients with gout.