[1]傅园园,罗厚龙,张和君,等.IgA肾病患者随机尿中ACR与24hUTP定量检测的相关性及其对临床诊断的一致性分析[J].现代检验医学杂志,2024,39(06):162-166.[doi:10.3969/j.issn.1671-7414.2024.06.028]
　FU Yuanyuan,LUO Houlong,ZHANG Hejun,et al.Correlation between Random Urinary ACR and 24 Hour UTP Quantification in Patients with IgA Nephropathy and Consistency Analysis of Clinical Diagnosis[J].Journal of Modern Laboratory Medicine,2024,39(06):162-166.[doi:10.3969/j.issn.1671-7414.2024.06.028]
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IgA肾病患者随机尿中ACR与24hUTP定量检测的相关性及其对临床诊断的一致性分析()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第39卷
期数:
2024年06期
页码:
162-166
栏目:
论著
出版日期:
2024-11-15

文章信息/Info

Title:
Correlation between Random Urinary ACR and 24 Hour UTP Quantification in Patients with IgA Nephropathy and Consistency Analysis of Clinical Diagnosis
文章编号:
1671-7414（2024）06-162-05
作者:
傅园园1; 罗厚龙2; 张和君1; 陈洁晶1
（1. 中国人民解放军联勤保障部队第九二四医院检验科，广西桂林541002；2. 北京大学深圳医院检验科，广东深圳 518036）
Author(s):
FU Yuanyuan1;  LUO Houlong2;  ZHANG Hejun1;  CHEN Jiejing1
（1.Department of Medical Laboratory, the 924th Hospital of the Joint Logistics Support of Chinese PLA, Guangxi Guilin 541002, China; 2.Department of Medical Laboratory, Peking University Shenzhen Hospital, Guangdong Shenzhen 518036, China）
关键词:
IgA 肾病; 随机尿清蛋白/ 肌酐比值; 24 h 尿蛋白定量
分类号:
R692；R446.12
DOI:
10.3969/j.issn.1671-7414.2024.06.028
文献标志码:
A
摘要:
目的 探讨IgA 肾病（immunoglobulin A nephropathy，IgAN）患者随机尿清蛋白/ 肌酐比值（albumin-to-creatinineratio, ACR）与24 h 尿蛋白定量（24 hour urine total protein quantification, 24hUTP）检测之间的相关性及其对临床诊断的一致性分析。方法 选取北京大学深圳医院2019 年1 月 ~ 2020 年12 月收治的230 例原发性IgAN 患者作为研究对象。采用相关性分析和组内相关系数（intraclass correlation coefficient, ICC）分析ACR 与24hUTP 间的相关性及其对临床诊断的一致性。应用不同慢性肾脏病（chronic kidney disease, CKD）分期和尿蛋白水平进行亚组分析。以24hUTP=0.5 g（24h），1.0 g（24h）和3.5 g（24h）为界点绘制受试者工作特征（receiver operating characteristic, ROC）曲线，确定ACR 的cut-off 值。结果 IgAN 患者ACR[0.79 (0.41~1.45) g/g] 与24 hUTP[1.02 (0.58~1.80) g/24h] 呈正相关（r=0.85，P<0.01），二者在临床诊断上的一致性程度中等（ICC=0.63，P<0.01）。亚组分析结果显示，二者的相关性和一致性不受CKD 分期影响，不同CKD 分期的二者相关系数（r）在0.76 ~ 0.86 之间（均P<0.01），组内相关系数（interclasscorrelation coefficient，ICC）在0.53 ~ 0.72 之间；受尿蛋白水平的影响，当24 hUTP ≤ 0.5 g/24h 时，二者无相关性（r=0.08，P>0.05），且在24 hUTP ≤ 0.5 g/24h，0.5 g/24h<24hUTP ≤ 1 g/24h 和24 hUTP>3.5 g/24h 三组中，二者的一致性可忽略（ICC均<0.20）。ROC 曲线分析结果显示，当24 hUTP=0.5 g/24h，1.0 g/24h 和3.5 g/24h 时，ACR 分别为0.30 g/g，0.57 g/g和1.28 g/g 时为其cut-off 值。结论 IgAN 患者中，ACR 不能简单地替代24 hUTP 进行尿蛋白水平评估。特别是在24hUTP ≤ 1 g/24h 和24 hUTP>3.5 g/24h 的时候，ACR 不能准确地反映真实的尿蛋白水平。
Abstract:
Objective To investigate the correlation between random urinary albumin-to-creatinine ratio (ACR) and 24 hour urine total protein quantification (24h UTP) in patients with immunoglobulin A nephropathy (IgAN), and analyze the consistency of these methods in clinical diagnosis. Methods A total of 230 patients with primary IgAN admitted to Peking University Shenzhen Hospital from January 2019 to December 2020 were selected as the research subjects. Correlation analysis and intraclass correlation coefficient (ICC) were used to assess the correlation between ACR and 24h UTP and their consistency in clinical diagnosis. Subgroup analysis was performed using different chronic kidney disease (CKD) stages and urine protein levels. Receiver operating characteristic (ROC) curves were plotted with 24h UTP=0.5 g/24h, 1.0 g/24h and 3.5 g/24h as boundary points to determine the optimal cut-off values for ACR. Results There was a positive correlation between ACR [0.79 (0.41~1.45) g/g] and 24h UTP [1.02 (0.58~1.80) g/24h] in patients with IgAN (r=0.85, P<0.01), and the consistency in clinical diagnosis between the two methods was moderate (ICC=0.63, P<0.01). Subgroup analysis revealed that the correlation and consistency between ACR and 24h UTP was not affected by CKD stages, with correlation coefficients(r) of different CKD staging ranging from 0.76 and 0.86 (all P<0.01) and ICC values ranging from 0.53 and 0.72 across different CKD stages. However, it was affected by urine protein level. When 24h UTP was ≤ 0.5 g/24h, there was no significant correlation between ACR and 24h UTP (r=0.08, P>0.05). In subgroups with 24h UTP ≤ 0.5 g/24h, 0.5 g/24h<24h UTP ≤ 1 g/24h and 24h UTP>3.5 g/24h, the consistency between the two methods was negligible (all ICC <0.20). ROC curve results showed that when 24h UTP=0.5 g/24h, 1.0 g/24h and 3.5 g/24h, the optimal cut-off values of ACR were 0.30 g/g, 0.57 g/g and 1.28 g/g, respectively. Conclusion In IgAN patients, ACR cannot simply replace 24h UTP for urine protein level evaluation. Especially when 24h UTP ≤ 1 g/24h and 24h UTP>3.5 g/24h, ACR may not accurately reflect the true urine protein level.

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备注/Memo

备注/Memo:
基金项目：广西自然科学基金资助项目（编号：2019JJA140468）；北京大学深圳医院科研基金资助项目（编号：JCYJ2021008）。
作者简介：傅园园（1985-），女，本科，主管技师，研究方向：IgA 肾病的诊断和发病机制，E-mail: 283617131@qq.com。
通讯作者：陈洁晶（1976-），女，硕士，主任技师，研究方向：肾脏相关疾病，E-mail: jiejingchen@126.com。
更新日期/Last Update: 2024-11-15