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| Clinical application value of urinary trace proteins combined detection in the diagnosis of early renal injury in chronic kidney diseases |
| CHEN Peng1 WANG Xiaoqin2 WANG Lan2,3 WU Wenjing2,3 LONG Sijie1 |
1.Department of Clinical Laboratory, Academy of Traditional Chinese Medicine Hubei Provincial Hospital of Traditional Chinese Medicine, Hubei Province, Wuhan 430074, China;
2.Department of Nephrology, Academy of Traditional Chinese Medicine Hubei Provincial Hospital of Traditional Chinese Medicine, Hubei Province, Wuhan 430074, China;
3.the First Clinical College, Hubei University of Chinese Medicine, Hubei Province, Wuhan 430065, China |
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Abstract Objective To investigate the clinical application value of urinary trace proteins combined detection in the diagnosis of early renal injury in chronic kidney diseases. Methods According to calculated estimated glomerular filtration rate（eGFR）and staging criteria, 521 patients with clinically diagnosed chronic kidney diseases were enrolled and divided into five groups including phase Ⅰ(222 cases), phase Ⅱ（130 cases）, phase Ⅲ（105 cases）, phase Ⅳ（39 cases）, phase Ⅴ（25 cases） in Hubei Provincial Hospital of Traditional Chinese Medicine （“our hospital” for short） from August 2015 to August 2018, while another 86 healthy subjects of our hospital were selected as normal control group. Six urinary trace proteins [Urine retinol binding protein (URBP), urine microalbumin (UmAlb), urine beta 2-microglobulin (Uβ2M), urine transferrin (UTRF), urine immunoglobulin (UIgG) and urine N-acetyl-beta-D glucosamine (UNAG)] and serum creatinine were detected respectively. The results of each group were compared, while analysed the relevance and diagnostic efficiency of urinary trace proteins, and their correlation and consistency with the stages of chronic kidney diseases. The clinical application value of single and combined detection of these markers in the diagnosis of early renal injury in chronic kidney diseases were evaluated. Results The levels of six urinary trace proteins in chronic kidney disease group were higher than those in normal control group, while increased significantly with the progression of disease, and the differences were highly statistically significant (P ＜ 0.01). The relevance of URBP and Uβ2MG as well as UTRF and UmAlb (rp = 0.789, 0.940) was high. Moreover, urinary trace protein UmAlb, UTRF and UIgG reflecting glomerular injury were well interrelated (all rp ＞ 0.6). Grade correlation analysis showed that Uβ2MG and URBP were significantly correlated with eGFR and stages of nephropathy, while other proteins were moderately correlated. However, UNAG was the worst. The correlation between six urinary trace proteins and the stages of chronic kidney diseases was ordinary, and the consistency was general (all Kappa ＜ 0.4). The diagnostic efficiency of urinary trace proteins combined detection was not only superior to that of single index (AUC ＞ 0.958), but also superior to that of serial mode in terms of correlation and consistency with the stages of chronic kidney diseases. Conclusion Urinary trace proteins have their own biological characteristics, and each of them has its own advantages in evaluating early renal injury in chronic kidney diseases. The combined detection of urinary trace proteins has high diagnostic performance and can significantly improve the diagnostic efficiency. It has high clinical application value for early diagnosis, pathological classification, staging monitoring and prognosis evaluation of renal injury in chronic kidney diseases.
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[1] Zhang L，Wang F，Wang L，et al. Prevalence of chronic kidney disease in China：a cross-sectional survey [J]. Lancet，2012，379（9818）：815-822.
[2] Al-Rubeaan K，Siddiqui K，Al-Ghonaim MA，et al. Assessment of the diagnostic value of different biomarkers in relation to various stages of diabetic nephropathy in type 2 diabetic patients [J]. Sci Rep，2017，7（1）：2684.
[3] 王汉敏，饶珺，赵妍，等.CKD-EPI开发方程在评价慢性肾脏病患者病情中的作用[J].国际检验医学杂志，2015， 36（11）：1515-1517.
[4] Levin A，Stevens PE，Bilous RW，et al. Kidney Disease：Improving Global Outcomes（KDIGO）CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease [J]. Kidney Int，2013，3（1）：1-150.
[5] 杨渝伟，曾平，张林，等.慢性肾病患者基于血清胱抑素C与肌酐的肾小球滤过率估算方程的建立和评价[J].中华检验医学杂志，2013，36（4）：352-359.
[6] 张路霞，王海燕.中国慢性肾脏病的高患病率及其对检验医学的挑战[J].中华检验医学杂志，2012，35（9）：769-772.
[7] ■y?覥ka A，Dumnicka P，Ku■nierz-Cabala B，et al. Markers of glomerular and tubular damage in the early stage of kidney disease in type 2 diabetic patients [J]. Mediators Inflamm，2018，2018：1-12.
[8] Fiseha T，Tamir Z. Urinary markers of tubular injury in early diabetic nephropathy [J]. Int J Nephrol，2016，2016：1-10.
[9] Lee SY，Choi ME. Urinary biomarkers for early diabetic nephropathy：beyond albuminuria [J]. Pediatr Nephrol，2015， 30（7）：1063-1075.
[10] 李萍，薛邦禄，徐维家.尿视黄醇结合蛋白在早期肾损伤中的诊断价值[J].国际检验医学杂志，2013，34（22）：3005-3006.
[11] 赖馨，陈丽芳，万彦彬.糖尿病肾病4项指标联合检测的临床价值[J].国际检验医学杂志，2015，36（11）：1593-1594.
[12] 严跃红，傅君舟，关昌杰，等.三种CKD-EPI方程在我国糖尿病肾病患者中适用性的对比研究[J].中华肾脏病杂志，2016，32（1）：9-15.
[13] 向代军，张洪瑞，白洁，等.尿α1微球蛋白和β2微球蛋白对2～4期慢性肾病患者的诊断价值[J].检验医学与临床，2014，11（8）：1011-1012.
[14] Zhou LT，Lv LL，Pan MM，et al. Are urinary tubular injury markers useful in chronic kidney disease? a systematic review and meta analysis [J]. PLoS One，2016，11（12）：e0167334.
[15] 郭玮，潘柏申.从K/DOQI2002到KDIGO2012慢性肾脏疾病诊疗指南中实验室检测项目相关应用建议的解读[J].检验医学，2015，30（7）：663-667.
[16] 刘红，尹传妍，岳华，等.联合生物标志物检测在慢性肾脏疾病中的临床研究[J].国际泌尿系统杂志，2013，33（6）：769-773.
[17] Gluhovschi C，Gluhovschi G，Petrica L，et al. Urinary bi-omarkers in the assessment of early diabetic nephropathy [J]. J Diabetes Res，2016，2016：1-13.
[18] 郝坡，孟凡萍.ROC曲线评价多参数对2型糖尿病早期肾损伤的预警作用[J].检验医学与临床，2015，12（19）：2852-2853.
[19] 周达.尿MA、β2-MG、TRF、α1-MG测定对2型糖尿病肾功能损害的应用价值[J].国际检验医学杂志，2013， 34（16）：2193-2194.
[20] Uwaezuoke SN. The role of novel biomarkers in predicting diabetic nephropathy：a review [J]. Int J Nephrol Renovasc Dis，2017，10：221-231.
[21] 王国政，周华君，金美彤，等.尿β2-微球蛋白测定影响因素的实验评价及纠正方法[J].现代检验医学杂志，2013， 28（1）：111-113. |
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