尿微量蛋白测定在狼疮肾炎中的诊断价值及其相关因素分析
发布时间：2018-07-14 18:08
【摘要】：目的 通过检测狼疮肾炎(lupus nephritis,LN)患者尿微量蛋白(包括尿微量白蛋白、转铁蛋白、IgG)、晨尿蛋白的水平,评价尿微量蛋白作为诊断狼疮性肾炎和评估蛋白尿水平的价值,并探讨相关影响因素。 方法 回顾性分析2011年6月～2013年2月浙江大学医学院附属第二医院风湿科的LN患者,收集其一般临床资料,血生化指标、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为狼疮性肾炎诊断的特异性、敏感性,同时评估不同尿微量蛋白检测指标与24小时尿蛋白定量间的一致性,及其一致性的相关影响因素,并分析不同组合的检测效能。 结果 1、纳入本研究的LN患者为382例,其中男性22例,女性360例,平均年龄31±10.95岁,平均病程9±7.71年。患者晨尿蛋白与24h尿蛋白定量呈显著正相关(ρ=0.740,P0.001)；以24h尿蛋白定量≥500mg,相应的晨尿蛋白ROC曲线下面积为0.850,对应的诊断界值为晨尿蛋白≥2+,其诊断的敏感性和特异性分别为69.1%和90.3%,阳性拟然率为7.1,阴性拟然率为0.3；以晨尿蛋白≥1+为阳性界点判断狼疮性肾炎的假阳性率为44.6%,假阴性率为10.8%,与24h尿蛋白定量相比差异有显著性(McNemar's test,P0.001),两种检验的κ=0.452； 2、尿微量蛋白(包括尿微量白蛋白、转铁蛋白、IgG)均与24h尿蛋白定量具有相关性(p=0.832,0.839,0.777, P0.001),24h尿蛋白定量≥500mg相应尿微量白蛋白与转铁蛋白的ROC曲线下面积均大于0.9,尿微量白蛋白、尿转铁蛋白、尿IgG的autoff值分别为289.1mg/g·Cr.25.8mg/g·Cr,37.8mg/g.Cr,与24小时尿蛋白定量一致性分别为κ=0.692、κ=0.704、κ=0.634. 3、将尿微量白蛋白、转铁蛋白、IgG和尿常规尿蛋白半定量进行串联检测(无论2种、3种还是4种)均能显著降低检测的假阳性率,却使假阴性率大大升高,且与24h尿蛋白定量检测的一致性(κ值)均小于0.700；而将尿微量白蛋白和尿转铁蛋白并联及尿转铁蛋白和IgG并联检测两者的假阳性与假阴性率均不高,且与24hr尿蛋白定量检测的一致性(κ值)均大于0.700； 4、分别以500mg/24hr、289.1mg/hCr作为阳性界点,将两者结果的一致性与否作为自变量,考察与之相关的应变量。经Logistic回归发现血清白蛋白(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).尿转铁蛋白(B=0.024,X2=6.756,P=0.010)与两者结果的一致性有关。 分别以500mg/4hr.25.8mg/gCr作为阳性界点,将两者结果的一致性与否作为自变量,考察与之相关的应变量。经Logistic回归发现血清白蛋白(B=0.067,χ2=5.308,P=0.021)、尿常规pH值(B=0.963,X2=9.464,P=0.002).血清IgG(B=0.010,X2=8.631,P=0.003)与两者结果的一致性有关。 分别以500mg/24hr.37.8mg/gCr作为阳性界点,将两者结果的一致性与否作为自变量,考察与之相关的应变量。经Logistic回归发现尿常规pH值(B=0.818,χ2=7.266,P=0.007)、尿转铁蛋白(B=0.012,χ2=7.409,P=0.006)与两者结果的一致性有关。 分别以500mg/24hr.2+作为阳性界点,将两者结果的一致性与否作为自变量,考察与之相关的应变量。经Logistic回归发现血清白蛋白(B=0.050,χ2=3.726,P=0.054)、尿转铁蛋白(B=0.007,)X2=9.151,P=0.002)与两者结果的一致性有关。 结论 1、晨尿常规蛋白半定量对诊断狼疮性肾炎和监测蛋白尿水平的价值有限,诊断的错误率较高。 2、尿微量白蛋白、转铁蛋白、IgG是反应狼疮性肾炎患者蛋白尿水平的敏感且相对特异性的指标,两两并联对诊断狼疮性肾炎的价值更优。 3、尿微量蛋白检测与24hr尿蛋白定量结果的一致性受血清白蛋白、血肌酐、血低密度脂蛋白、血IgG水平及尿常规pH值等因素的影响。
[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.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R593.242
本文编号：2122529
[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.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R593.242
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