慢性肾脏病患者晨尿尿蛋白肌酐比值与24 h尿蛋白定量的相关性和一致性分析

张妙; 胡炀琳; 万家颖; 谢小行; 黄芬芬; 熊飞

doi:10.3969/j.issn.1671-2390.2023.01.007

慢性肾脏病患者晨尿尿蛋白肌酐比值与24 h尿蛋白定量的相关性和一致性分析

Correlation and consistency analysis of urinary protein-creatinine ratio and 24-h urine protein quantification in patients with chronic kidney disease

摘要

摘要: 目的对慢性肾脏病（chronic kidney disease，CKD）患者的晨尿尿蛋白肌酐比值（urinary protein-creatinine ratio，uPCR）与24 h尿总蛋白定量（24 hour urine total protein quantification，24 hUTP）进行相关性和一致性分析，评估用晨尿uPCR来替代24 hUTP的可行性。方法回顾性分析2019年1月1日至2021年12月31日在武汉市第一医院肾内科住院就诊的1793例CKD非透析患者临床资料，采用Spearman相关性分析和组内相关系数（intraclass correlation coefficient，ICC）分析两者的相关性和一致性，并从不同CKD分期、24 hUTP、原发病进行分组比较。同时以24 hUTP 0.15 g、1.0 g、3.5 g为三个界点绘制uPCR的接受者操作特性（receiver operating characteristic，ROC）曲线，确定晨尿uPCR的最佳诊断临界值。结果 CKD患者的晨尿uPCR与24 hUTP呈正相关（r=0.880，P<0.001），两者的相关性不受CKD分期、原发病影响，不同CKD分期、不同原发病的两者相关系数r在0.688~0.911之间（P均<0.001），受蛋白尿水平影响，当24 hUTP ≤ 150 mg和24 hUTP>3.5 g时，r为0.300、0.380（P均<0.001），相关性减弱。两者一致性中等（ICC=0.618，P<0.001），在不同CKD、原发病分组中，两者的ICC值在0.336~0.710之间。不同24 hUTP分组中，两者ICC值均小于0.29。绘制不同的ROC曲线结果显示，当24 hUTP为0.15 g、1.0 g、3.5 g时，晨尿uPCR分别为0.335 g/g、0.975 g/g、2.38 g/g时为其最佳诊断临界值。结论在CKD患者中，晨尿uPCR与24 hUTP有较好的相关性，两者的相关性不受CKD分期、原发病影响，受蛋白尿水平影响，当24 hUTP>3.5 g或 ≤ 150 mg时，两者的相关性减弱，但两者的一致性一般，在临床中晨尿uPCR不能简单地等同于24 hUTP，仍需大量的前瞻性研究来重新界定uPCR的相关阈值。

Abstract: Objective To explore the correlation and consistency between morning urinary protein-creatinine ratio(uPCR) and 24 h urine total protein quantification(24 hUTP) in chronic kidney disease(CKD) patients for evaluating the feasibility of replacing 24 hUTP with morning uPCR.Methods Clinical data were retrospectively reviewed for 1793 CKD non-dialysis from January 1, 2019 to December 31, 2021.Spearman's correlation analysis was utilized for examining the correlation and intraclass correlation coefficient(ICC) for evaluating the consistency in different methods of urinary protein detection.Comparisons were also performed for different CKD stages, 24 hUTP and primary diseases.Receiver operating characteristic(ROC) curves of morning uPCR were plotted separately using 24 hUTP 0.15 g, 1.0 g, 3.5 g as three critical points for determining the optimal diagnostic value of morning uPCR for predicting 24 hUTP.Results A positive correlation existed between morning urinary uPCR and 24 hUTP in CKD patients(r=0.880, P<0.001).The correlation was not affected by CKD stage or primary disease, r was between 0.688 and 0.911(both P<0.001) while it was affected by the level of proteinuria.In 24 hUTP ≤ 150 mg and 24 hUTP>3.5 g groups, the associations of morning uPCR with 24 hUTP were weaker, r were 0.300 and 0.380 respectively(both P<0.001).A moderate consistency existed between morning uPCR and 24 hUTP(ICC=0.618, P<0.001).Across different CKD groups and primary diseases, ICC values were between 0.366 and 0.710(P<0.001).However, in comparison between different 24 hUTP groups, the consistencies between uPCR and 24 hUTP were negligible and ICC values were all less than 0.29.ROC analysis showed that, when 24 hUTP was 0.15 g, 1 g, 3.5 g, morning urinary uPCR was 0.335 g/g, 0.975 g/g, 2.38 g/g as its optimal diagnostic value.Conclusion In CKD patients, morning uPCR has an excellent correlation with 24 hUTP.The correlation is not affected by CKD stage or primary disease, but affected by proteinuria level.When 24 hUTP>3.5 g or ≤ 150 mg, the associations are weaker.Morning uPCR amount cannot be simply equated to 24 hUTP amount.Large prospective studies are still required for redefining the correlation threshold of uPCR.

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