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原发性肾小球疾病中尿蛋白肌酐比值评估24小时尿蛋白的诊断精确性:一个纵向研究

    文献标题:Diagnostic accuracy of the protein/creatinine ratio in urine samples to estimate 24-h proteinuria in patients with primary glomerulopathies: a longitudinal study
    文献来源:Nephrol Dial Transplant. 2008 Feb 15 
    期刊影响因子:3.306
    PMID:
18281321

    背景和目的:尿液样本的蛋白/肌酐比值(P/C)一直用于肾小球疾病患者的临床处理中。本研究的目标是对蛋白/肌酐比值精确度在决定肾小球疾病患者蛋白尿临界水平中的作用进行前瞻性评估。


    试验设计,设置,参与者和测量方法
。本研究为纵向研究,共选取41个患原发性肾小球疾病的成人,应用免疫抑制剂或血管紧张素转换酶抑制剂治疗,并进行6个月的随访。对24小时尿蛋白定量和蛋白/肌酐比的关联和一致性进行评价。应用Kappa统计对临床相关的两种蛋白尿分类评估方法进行一致性评价。重复测量结果采用ANOVA统计进行。采用ROC评估P/C比值的诊断准确率。


图1 24 h尿蛋白以及 蛋白/肌酐比值:基础值(0 月)及6个
时间点的观测值。P/C:蛋白/肌酐  P24: 24小时蛋白尿

    结果:6个月随访期内,24小时尿蛋白定量和蛋白/肌酐比之间有显著的关联(各方面 P < 0.001)。基线值和1到6月,24小时尿蛋白定量和蛋白/肌酐比之间的平均差异分别是2.00, 1.88, 1.22, 1.07, 0.65, 0.34 和 0.57。尽管24小时尿蛋白定量和蛋白/肌酐比在高水平的蛋白尿有较低的一致性,我们发现在各时期Kappa对于蛋白尿的分类有价值。ROC考虑24小时尿蛋白定量除去0.20 g 和 3.5 g后,显示蛋白/肌酐比准确度佳,分别有曲线下面积0.99(95% CI: 0.97-1.00)和0.99 (95% CI: 0.99-1.00)。

    结论:这个纵向分析证实了先前横断面研究的发现,支持用蛋白/肌酐比(P/C)作为界定蛋白尿临界水平的准确指标。


附英文原文摘要:

Diagnostic accuracy of the protein/creatinine ratio in urine samples to estimate 24-h proteinuria in patients with primary glomerulopathies: a longitudinal study.

Nephrol Dial Transplant. 2008 Feb 15 

Post Graduate Program in Medical Sciences: Nephrology, School of Medicine, Universidade Federal do Rio Grande do Sul and Division of Nephrology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.

Background and objectives.
The protein/creatinine (P/C) ratio in urine samples has been used in the clinical management of patients with glomerular diseases. The aim of this study is to perform a prospective evaluation of the P/C ratio accuracy in determining critical levels of proteinuria in patients with glomerulopathies.

Design, setting, participants and measurements. This is a longitudinal study of 41 adult patients with primary glomerulopathies treated with immunosuppressive drugs or angiotensin-converting enzyme inhibitors in a 6-month follow-up. Correlation and agreement level between P24 and the P/C ratio were evaluated. Kappa statistic was employed to evaluate concordance between the two methods taking into account clinically relevant categories of proteinuria. ANOVA for repeated measures was employed. Diagnostic accuracy of the P/C ratio was evaluated by receiver-operator curves (ROC).

Results: There was a significant correlation between P24 and the P/C ratio during the 6-month period (P < 0.001 in all time points). Mean differences between P24 and P/C ratios at baseline and from the first to the sixth month were 2.00, 1.88, 1.22, 1.07, 0.65, 0.34 and 0.57 respectively. In spite of the lower agreement between P24 and the P/C ratio for higher levels of proteinuria, we found substantial Kappa values for categories of proteinuria in all periods. ROC considering the cut-off levels of 0.20 g and 3.5 g for P24 showed that the P/C ratio had a very good accuracy, with areas under the curve of 0.99 (95% CI: 0.97-1.00) and 0.99 (95% CI: 0.99-1.00), respectively.

CONCLUSION: This longitudinal analysis corroborates the findings of previous cross-sectional studies, supporting the use of the P/C ratio as an accurate test to define critical levels of proteinuria.

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