摘要
目的探讨应用尿微量白蛋白(UM-Alb)、尿β2-微球蛋白(Uβ2-MG)和尿N-乙酰-β-D氨基葡萄糖苷酶(NAG-U)评估失代偿期肝硬化患者肾损伤的效能。方法2016年9月~2021年4月我院诊治的135例失代偿期肝硬化患者,采用免疫散射比浊法检测UM-Alb和Uβ2-MG,采用对硝基苯酚比色法检测NAG-U水平。应用受试者工作特征曲线(ROC)评估UM-Alb、Uβ2-MG和NAG-U评估肾损伤的效能。结果参照2012年改善全球肾脏病预后指南的标准,本组发现肾损伤患者75例(1期41例,2期19例,3期15例);肾损伤组UM-Alb、Uβ2-MG和NAG-U水平分别为(34.4±10.6)mg/L、(3.4±0.6)mg/L和(14.7±3.6)U/L,均显著高于非肾损伤组【分别为(15.8±4.1)mg/L、(1.1±0.3)mg/L和(9.9±2.7)U/L,P<0.05】;肾损伤3期患者UM-Alb、Uβ2-MG和NAG-U水平分别为(49.1±9.3)mg/L、(4.9±0.7)mg/L和(21.9±4.9)U/L,显著高于1期患者【分别为(27.9±7.6)mg/L、(2.6±0.5)mg/L和(11.2±3.1)U/L,P<0.05】或2期患者【分别为(36.8±8.4)mg/L、(3.9±0.4)mg/L和(16.6±3.4)U/L,P<0.05】;分别以UM-Alb>26.6 mg/L、Uβ2-MG>2.5 mg/L和NAG-U>11.3 U/L为截断点,联合评估失代偿期肝硬化患者肾损伤发生的曲线下面积(AUC)为0.908,显著大于三项指标单独评估(分别为0.793、0.809和0.787,P<0.05),联合评估的灵敏度、特异度和准确度分别为86.7%、85.0%和85.9%。结论失代偿期肝硬化患者容易发生肾损伤,检测UM-Alb、Uβ2-MG和NAG-U水平可以帮助诊断,取材方便,有一定的临床意义,值得进一步研究。
Objective The aim of this study was to explore the diagnostic efficacy of urine microalbumin(UM-Alb),β2-microglobulin(Uβ2-MG)and N-acetyl-beta-glucosaminidase(NAG-U)levels for renal injury in patients with decompensated liver cirrhosis(LC).Methods A total of 135 patients with decompensated LC cirrhosis were enrolled in our hospital between September 2016 and April 2021.Urine UM-Alb and Uβ2-MG levels were detected by immune scatter turbidity,and NAG-U level was assayed by p-nitrophenol colorimetry.The diagnostic efficacy of urine parameters was evaluated by receiver operating characteristic curve(ROC).Results Out of our series,the renal injury was found based on KDIGO clinical practice guidelines for acute kidney injury in 75 patients(stage I in 41 cases,stage II in 19 cases and stage III in 15 cases);the UM-Alb,Uβ2-MG and NAG-U levels in patients with renal injury were(34.4±10.6)mg/L,(3.4±0.6)mg/L and(14.7±3.6)U/L,all significantly higher than[(15.8±4.1)mg/L,(1.1±0.3)mg/L and(9.9±2.7)U/L,respectively,P<0.05]in those without;the UM-Alb,Uβ2-MG and NAG-U levels in patients with renal injury stage III were(49.1±9.3)mg/L,(4.9±0.7)mg/L and(21.9±4.9)U/L,all significantly higher than[(27.9±7.6)mg/L,(2.6±0.5)mg/L and(11.2±3.1)U/L,respectively,P<0.05]in patients with renal injury stage I or[(36.8±8.4)mg/L,(3.9±0.4)mg/L and(16.6±3.4)U/L,respectively,P<0.05]in patients with renal injury stage II;the area under the curve(AUC)of UM-Alb,Uβ2-MG and NAG-U combination with the cut-off-value of>26.6 mg/L,>2.5 mg/L and>11.3 U/L,respectively,for diagnosing renal injury was 0.908,significantly greater than 0.793,0.809 and 0.787 by any one parameter alone(P<0.05),which had a higher sensitivity,specificity and accuracy of 86.7%,85.0%and 85.9%,respectively.Conclusion The patients with decompensated LC is prone to renal injury,and the detection of UM-Alb,Uβ2-MG and NAG-U levels might help diagnose in time,which warrants further clinical investigation.
作者
龚豪
黄丽
张庆红
李涛
史秀岩
Gong Hao;Huang Li;Zhang Qinghong(Department of Nephrology,Taihe Hospital Affiliated to Hubei Medical Pharmacy College,Shiyan 442000,Hubei Province,China)
出处
《实用肝脏病杂志》
CAS
2022年第5期681-684,共4页
Journal of Practical Hepatology
基金
湖北省卫生与健康委员会科研基金面上项目(编号:WJ2020M128)。
