【作者】 高丹； 卢丽萍； 秦晓松； 刘勇；

【Author】 Gao Dan;Lu li-ping;Qin Xiao-song;Liu Yong;Department of clinical laboratory,Shengjing Hospital of China Medical University;

【机构】 中国医科大学附属盛京医院检验科；

【摘要】 目的:探讨尿液足细胞标志蛋白/尿肌酐[Podocalyxin(PCX)/Ucrea(CR)]检测在鉴别血尿来源和早期诊断肾脏损伤方面的应用价值。方法:1、选取首次入肾内科未经肾脏疾病系统治疗,并经肾穿刺活检,且尿液红细胞>3/HP的患者96例(肾小球性血尿组),经过影像学等检查证实为非肾性疾病者40例(非肾小球性血尿组);选取体检健康人群40例为对照组。留取清晨首次尿标本,分别进行UF-1000i尿沉渣分析仪检测,普通光学显微镜尿红细胞形态分析,ELISA方法测定尿PCX,同时测定尿CR,并得出PCX/CR值。2、测定肾小球性血尿组尿α1-球蛋白、微量白蛋白、转铁蛋白、24小时尿蛋白定量、血肌酐、尿素、胱抑素C水平,并分析和评价PCX/CR与肾损伤标志物的关系。结果:1、肾小球性血尿组尿PCX/CR为(3.79±3.71)mg/g,非肾小球性血尿组尿PCX/CR为(1.23±1.15)mg/g,健康对照组尿PCX/CR为(1.16±1.65)mg/g。肾小球性血尿组尿PCX/CR均高于非肾小球性血尿组及健康对照组,差异均有显著的统计学意义(F=17.392,P<0.01),而非肾小球性血尿组与健康对照组比较,差异无显著的统计学意义(P=0.916)。2、尿红细胞形态方法鉴别血尿来源的ROC曲线下面积为0.986;UF1000i方法的曲线下面积0.964,而PCX/CR采用1.725mg/g为cutoff值,其曲线下面积0.797。说明前两种方法优于PCX/CR。3、以肾脏病理诊断及临床确定诊断结果为金标准,普通光学显微镜尿红细胞形态分析在鉴别血尿来源方面一致性好(kappa=0.780,P<0.01),UF-1000i尿沉渣分析仪红细胞信息提示在鉴别血尿来源方面一致性较好(kappa=0.666,P<0.01),应用尿PCX/CR在鉴别血尿来源方面一致性一般(kappa=0.451,P<0.01)。4、肾脏病理诊断膜性肾病、IgA肾病、过敏性紫癜性肾炎和狼疮性肾炎患者的尿PCX/CR明显高于健康对照组,差异均具有统计学意义(F值分别为12.621,5.957,6.686,40.695,P均<0.05)。5、肾小球性血尿组尿PCX/CR与血肌酐、尿素、胱抑素C呈正相关(r=0.342,0.246,0.444,P=0.001,0.016,0.000)与24小时尿蛋白定量、α1-微球蛋白、微量白蛋白、转铁蛋白无相关性。结论:尿PCX/CR检测与UF-1000i尿沉渣分析仪检测和普通光学显微镜尿红细胞形态分析鉴别血尿来源相比,它可以作为判断肾小球性与非肾小球性血尿的一个指标,具有一定的诊断价值,同时对评估早期肾小球损害的诊断具有一定作用。更多还原

【Abstract】 Objective:Explore the urine sufficient cell marker protein/urinary creatinine[Podocalyxin(PCX)/Ucrea(CR)]detection in identifying the source of hematuria and the application value of early diagnosis of kidney damage.Methods:1.Select 96 cases of patients who are the first time into the renal medicine without kidney disease treatment,and the renal biopsy,and urine RBC>3/HP,(glomerular hematuria group),after the examination such as imaging confirmed for 40 cases of non-renal disease(non glomerular hematuria group);Select a medical healthy people 40 cases as control group.Collect early morning urine specimen for the first time,respectively to UF-1000 i urine sediment analyzer,ordinary optical microscopy urine red blood cell morphological analysis,ELISA method for determination of urinary PCX,determination of urinary CR at the same time,and it is concluded that the PCX/CR.2.Determination of glomerular hematuria group a1-globulin,microalbumin,transferrin,24 hours urinary protein,serum creatinine,blood uric acid,cystain C level,and analyze and evaluate the PCX/CR’s relationship with markers of kidney injury.Results:1.Glomerular hematuria group urine PCX/CR(3.79 ± 3.71) mg/g,non glomerular hematuria group urine PCX/CR(1.23 ± 1.15)mg/g,healthy controls urine PCX/CR(1.16 ± 1.65) mg/g.Glomerular hematuria group compared with non glomerular hematuria group and healthy control group,the differences were statistically significant(F=17.392,P< 0.01),the glomerular hematuria group compared with healthy controls,there was no statistically significant difference(P= 0.916).2.Urinary red cell morphology method to identify the source of hematuria area under the ROC curve is 0.986;UF1000i method area under the curve of 0.964,while the PCX/CR with 1.725 mg/g for cutoff value,the area under curve of 0.797.The former two methods is superior to PCX/CR.3.The kidney pathological diagnosis and clinical diagnosis was confirmed as the gold standard,ordinary optical microscopy urine red blood cell morphological analysis in identifying hematuria sources are better consistency(kappa=0.780,P< 0.01),and UF 1000 i urine sediment analyzer RBC message are prompt good consistency in terms of identifying hematuria source(kappa= 0.666,.P< 0.01),theapplication of urine PCX/CR in identifying hematuria sources is general consistency(kappa=0.451,P< 0.01).4.Kidney pathological diagnosis of IgA nephropathy membranous nephropathy allergic purpura nephritis and urine of patients with lupus nephritis PCX/CR is significantly higher than healthy control group,differences were statistically significant(F=12.621,5.957,6.686,40.695,P< 0.05).5.Glomerular hematuria group,PCX/CR were positively correlated with serum creatinine,blood urea,cystain C(r= 0.342,0.246,0.444,/M).001,0.016,0.000),and 24 hours urinary protein,α 1-microglobulin,trace albumin,transferrin has no relevance.Conclusion:Urine PCX/CR test can be used as a judgment of glomerular and an indicator of glomerular hematuria,and has certain diagnostic value,but with UF-1000 i urine sediment analyzer and ordinary optical microscope compared urinary erythrocytes morphological analysis to identify sources of blood in the urine.and has aneffect in early glomerular damage assessment.更多还原