【摘要】：目的 通過檢測(cè)狼瘡腎炎(lupus nephritis,LN)患者尿微量蛋白(包括尿微量白蛋白、轉(zhuǎn)鐵蛋白、IgG)、晨尿蛋白的水平,評(píng)價(jià)尿微量蛋白作為診斷狼瘡性腎炎和評(píng)估蛋白尿水平的價(jià)值,并探討相關(guān)影響因素。 方法 回顧性分析2011年6月～2013年2月浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院風(fēng)濕科的LN患者,收集其一般臨床資料,血生化指標(biāo)、24h尿蛋白水平,晨尿蛋白半定量及微量尿蛋白水平。分析尿微量蛋白定量水平作為狼瘡性腎炎診斷的特異性、敏感性,同時(shí)評(píng)估不同尿微量蛋白檢測(cè)指標(biāo)與24小時(shí)尿蛋白定量間的一致性,及其一致性的相關(guān)影響因素,并分析不同組合的檢測(cè)效能。 結(jié)果 1、納入本研究的LN患者為382例,其中男性22例,女性360例,平均年齡31±10.95歲,平均病程9±7.71年�；颊叱磕虻鞍着c24h尿蛋白定量呈顯著正相關(guān)(ρ=0.740,P0.001)；以24h尿蛋白定量≥500mg,相應(yīng)的晨尿蛋白R(shí)OC曲線下面積為0.850,對(duì)應(yīng)的診斷界值為晨尿蛋白≥2+,其診斷的敏感性和特異性分別為69.1%和90.3%,陽(yáng)性擬然率為7.1,陰性擬然率為0.3；以晨尿蛋白≥1+為陽(yáng)性界點(diǎn)判斷狼瘡性腎炎的假陽(yáng)性率為44.6%,假陰性率為10.8%,與24h尿蛋白定量相比差異有顯著性(McNemar's test,P0.001),兩種檢驗(yàn)的κ=0.452； 2、尿微量蛋白(包括尿微量白蛋白、轉(zhuǎn)鐵蛋白、IgG)均與24h尿蛋白定量具有相關(guān)性(p=0.832,0.839,0.777, P0.001),24h尿蛋白定量≥500mg相應(yīng)尿微量白蛋白與轉(zhuǎn)鐵蛋白的ROC曲線下面積均大于0.9,尿微量白蛋白、尿轉(zhuǎn)鐵蛋白、尿IgG的autoff值分別為289.1mg/g·Cr.25.8mg/g·Cr,37.8mg/g.Cr,與24小時(shí)尿蛋白定量一致性分別為κ=0.692、κ=0.704、κ=0.634. 3、將尿微量白蛋白、轉(zhuǎn)鐵蛋白、IgG和尿常規(guī)尿蛋白半定量進(jìn)行串聯(lián)檢測(cè)(無論2種、3種還是4種)均能顯著降低檢測(cè)的假陽(yáng)性率,卻使假陰性率大大升高,且與24h尿蛋白定量檢測(cè)的一致性(κ值)均小于0.700；而將尿微量白蛋白和尿轉(zhuǎn)鐵蛋白并聯(lián)及尿轉(zhuǎn)鐵蛋白和IgG并聯(lián)檢測(cè)兩者的假陽(yáng)性與假陰性率均不高,且與24hr尿蛋白定量檢測(cè)的一致性(κ值)均大于0.700； 4、分別以500mg/24hr、289.1mg/hCr作為陽(yáng)性界點(diǎn),將兩者結(jié)果的一致性與否作為自變量,考察與之相關(guān)的應(yīng)變量。經(jīng)Logistic回歸發(fā)現(xiàn)血清白蛋白(B=0.130,χ2=9.858,P=0.002)、血清肌酐(B=-0.008,X2=4.017,P=0.045).血清低密度脂蛋白(B=0.495,X2=3.971,P=0.046).尿轉(zhuǎn)鐵蛋白(B=0.024,X2=6.756,P=0.010)與兩者結(jié)果的一致性有關(guān)。 分別以500mg/4hr.25.8mg/gCr作為陽(yáng)性界點(diǎn),將兩者結(jié)果的一致性與否作為自變量,考察與之相關(guān)的應(yīng)變量。經(jīng)Logistic回歸發(fā)現(xiàn)血清白蛋白(B=0.067,χ2=5.308,P=0.021)、尿常規(guī)pH值(B=0.963,X2=9.464,P=0.002).血清IgG(B=0.010,X2=8.631,P=0.003)與兩者結(jié)果的一致性有關(guān)。 分別以500mg/24hr.37.8mg/gCr作為陽(yáng)性界點(diǎn),將兩者結(jié)果的一致性與否作為自變量,考察與之相關(guān)的應(yīng)變量。經(jīng)Logistic回歸發(fā)現(xiàn)尿常規(guī)pH值(B=0.818,χ2=7.266,P=0.007)、尿轉(zhuǎn)鐵蛋白(B=0.012,χ2=7.409,P=0.006)與兩者結(jié)果的一致性有關(guān)。 分別以500mg/24hr.2+作為陽(yáng)性界點(diǎn),將兩者結(jié)果的一致性與否作為自變量,考察與之相關(guān)的應(yīng)變量。經(jīng)Logistic回歸發(fā)現(xiàn)血清白蛋白(B=0.050,χ2=3.726,P=0.054)、尿轉(zhuǎn)鐵蛋白(B=0.007,)X2=9.151,P=0.002)與兩者結(jié)果的一致性有關(guān)。 結(jié)論 1、晨尿常規(guī)蛋白半定量對(duì)診斷狼瘡性腎炎和監(jiān)測(cè)蛋白尿水平的價(jià)值有限,診斷的錯(cuò)誤率較高。 2、尿微量白蛋白、轉(zhuǎn)鐵蛋白、IgG是反應(yīng)狼瘡性腎炎患者蛋白尿水平的敏感且相對(duì)特異性的指標(biāo),兩兩并聯(lián)對(duì)診斷狼瘡性腎炎的價(jià)值更優(yōu)。 3、尿微量蛋白檢測(cè)與24hr尿蛋白定量結(jié)果的一致性受血清白蛋白、血肌酐、血低密度脂蛋白、血IgG水平及尿常規(guī)pH值等因素的影響。
[Abstract]:objective
The value of urine microalbuminuria (including urinary microalbumin, transferrin, IgG), the level of morning urine protein and the value of urine microprotein as the diagnostic value of lupus nephritis and evaluation of proteinuria were evaluated by detecting lupus nephritis (LN), and the related factors were discussed.
Method
A retrospective analysis of the LN patients in the Department of rheumatism, Second Affiliated Hospital of Zhejiang University, from June 2011 to February 2013, was used to collect the general clinical data, blood biochemical indexes, 24h urine protein level, morning urine protein semi quantitative and microalbuminuria level, and analyze the specificity, sensitivity and sensitivity of urine microprotein quantitative level as the diagnosis of lupus nephritis. To evaluate the consistency of different urine microprotein detection indexes and 24 hour urine protein quantitation, and the correlation factors of their consistency, and to analyze the detection efficiency of different combinations.
Result
1, 382 cases of LN were included in this study, including 22 men and 360 women, with an average age of 31 + 10.95 years, with an average course of 9 + 7.71 years. The amount of morning urine protein was positively correlated with 24h urine protein (P =0.740, P0.001); the amount of 24h urine protein was equal to 500mg, the corresponding morning urine protein ROC curve was 0.850, and the corresponding diagnostic boundary value was morning The sensitivity and specificity of the urine protein were 69.1% and 90.3%, the positive rate was 7.1 and the negative percentage was 0.3. The false positive rate of the lupus nephritis was 44.6% and the false negative rate was 10.8%, with the morning urine protein more than 1+, and the difference was significant (McNemar's test, P0.001) compared with the 24h urine protein (McNemar's test, P0.001) and two tests. Kappa =0.452;
2, the urine microalbuminuria (including urine microalbuminuria, transferrin, IgG) was correlated with 24h urine protein quantitative (p=0.832,0.839,0.777, P0.001), the area of ROC curve under the ROC curve of 24h urine protein quantitative > 500mg corresponding urine microalbumin and transferrin was greater than 0.9, urinary albumin, urine transferrin and urine IgG autoff value respectively 289.1mg/g. The consistency of Cr.25.8mg/g, Cr, 37.8mg/g.Cr and 24 hours urine protein was =0.692, =0.704, kappa =0.634. respectively.
3, urine microalbuminuria, transferrin, IgG and urine routine urine protein semi quantitative series detection (no matter 2, 3 or 4) can significantly reduce the false positive rate, but the false negative rate is greatly increased, and the consistency of quantitative detection of 24h urine protein (kappa value) is less than 0.700; and urine albumin and urine transferrin, The false positive and false negative rates of the combination of TF and IgG were not high, and the consistency with the 24hr urine protein (kappa value) was greater than 0.700.
4, 500mg/24hr and 289.1mg/hCr were used as positive boundary points respectively, and whether the results were consistent or not were used as independent variables, and the related variables were investigated. Serum albumin (B=0.130, 2=9.858, P=0.002), serum creatinine (B=-0.008, X2=4.017, P= 0.045) were found by Logistic regression. Serum low density lipoprotein (B=0.495, X2=3.971, P=0.046). The protein (B=0.024, X2=6.756, P=0.010) is related to the consistency of the two results.
500mg/4hr.25.8mg/gCr was used as a positive boundary point respectively, and the consistency of the results was considered as the independent variable, and the related variables were investigated. The serum albumin (B=0.067, X 2=5.308, P=0.021) and urine routine pH value (B=0.963, X2=9.464, P=0.002) were found by Logistic regression. The consistency of serum IgG (B=0.010, X2=8.631, etc.) with the results of serum IgG (B=0.010, X2=8.631,) was consistent with the results. Of
500mg/24hr.37.8mg/gCr was used as a positive boundary point respectively, and the consistency of the results was considered as the independent variable, and the related variables were investigated. The urine routine pH value (B=0.818, X 2=7.266, P=0.007) and urinary transferrin (B=0.012, Chi 2=7.409, P=0.006) were found to be related to the consistency of the two results by Logistic regression.
500mg/24hr.2+ was used as a positive boundary point respectively, and the consistency of the results was considered as the independent variable, and the related variables were investigated. The serum albumin (B=0.050, X 2=3.726, P=0.054), and the urinary transferrin (B=0.007, X2=9.151, P=0.002) were found to be related to the consistency of the two results by Logistic regression.
conclusion
1, semiquantitative analysis of morning urine protein is of limited value in diagnosing lupus nephritis and monitoring proteinuria level, and the rate of error diagnosis is high.
2, urinary microalbuminuria, transferrin, and IgG are sensitive and specific indicators of the level of proteinuria in patients with lupus nephritis. The 22 parallel connection is more valuable in the diagnosis of lupus nephritis.
3, the consistency of Urine Microprotein Detection and 24hr urine protein quantitative results was influenced by serum albumin, serum creatinine, blood low density lipoprotein, blood IgG level and urine routine pH value.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R593.242

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