CAJ | 학술논문

目的探讨尿海藻糖酶(T)在近端肾小管损害中的价值.方法采用实验室指标对照研究,选取2005-2011年在内蒙古自治区人民医院就诊,确诊为肾脏疾病患者134例(男66例,女68例,年龄18 ～59岁)(急性肾功能衰竭31例、慢性肾功能衰竭30例、药物性肾损害20例、肾移植术后21例、肾病综合征32例)和101名健康对照者(男58名,女43名,年龄18～ 56岁)进行尿T及尿N-乙酰-β-D氨基葡萄糖苷酶(NAG)、r-谷氨酰转酞酶(GGT)、β2-微球蛋白(β2-MG)4项指标检测,建立受试者工作特征曲线(ROC)评价系统,比较尿T在近端肾小管损害中的价值.实验数据采用SPSS11.5统计软件进行非参数秩和检验、ROC曲线分析.结果 101名健康对照者尿T结果近似正态分布(Z=1.09,P=0.183),结果为(7.1±4.1)μmol/h·g Cr(0 ～25 μmol/h·g Cr)男女间差异无统计学意义(t=0.63,P＞0.05)；肾脏疾病各组尿T水平与对照组比较差异有统计学意义(Z =6.80、5.90、5.23、6.00、8.04,P均＜0.01).ROC曲线分析结果显示,134例患者尿T的ROC曲线下面积为0.9,与NAG、β2-MG、GGT曲线下面积比较差异有统计学意义(P均＜0.01)；分组研究结果显示:4项检测指标在急性肾功能衰竭、慢性肾功能衰竭、药物性肾损害、肾移植术后、肾病综合征组中以尿T的ROC曲线下面积最大(0.94、0.85、0.90、0.90、0.91)；尿T约登指数分别为0.85、0.65、0.77、0.66、0.72,其对应的诊断敏感度、特异度分别为90.3％、95.1％；73.3％、92.1％；85.0％、92.1％；81.0％、85.2％；87.5％、84.2％.结论尿T在反映近端肾小管损害的诊断价值优于其他指标,能更好地对近端肾小管功能进行早期判断,对肾脏疾病诊治及预后估计具有重要意义.
목적 탐토뇨해조당매(T)재근단신소관손해중적개치.방법 채용실험실지표대조연구,선취2005-2011년재내몽고자치구인민의원취진,학진위신장질병환자134례(남66례,녀68례,년령18 ～59세)(급성신공능쇠갈31례、만성신공능쇠갈30례、약물성신손해20례、신이식술후21례、신병종합정32례)화101명건강대조자(남58명,녀43명,년령18～ 56세)진행뇨T급뇨N-을선-β-D안기포도당감매(NAG)、r-곡안선전태매(GGT)、β2-미구단백(β2-MG)4항지표검측,건립수시자공작특정곡선(ROC)평개계통,비교뇨T재근단신소관손해중적개치.실험수거채용SPSS11.5통계연건진행비삼수질화검험、ROC곡선분석.결과 101명건강대조자뇨T결과근사정태분포(Z=1.09,P=0.183),결과위(7.1±4.1)μmol/h·g Cr(0 ～25 μmol/h·g Cr)남녀간차이무통계학의의(t=0.63,P＞0.05)；신장질병각조뇨T수평여대조조비교차이유통계학의의(Z =6.80、5.90、5.23、6.00、8.04,P균＜0.01).ROC곡선분석결과현시,134례환자뇨T적ROC곡선하면적위0.9,여NAG、β2-MG、GGT곡선하면적비교차이유통계학의의(P균＜0.01)；분조연구결과현시:4항검측지표재급성신공능쇠갈、만성신공능쇠갈、약물성신손해、신이식술후、신병종합정조중이뇨T적ROC곡선하면적최대(0.94、0.85、0.90、0.90、0.91)；뇨T약등지수분별위0.85、0.65、0.77、0.66、0.72,기대응적진단민감도、특이도분별위90.3％、95.1％；73.3％、92.1％；85.0％、92.1％；81.0％、85.2％；87.5％、84.2％.결론 뇨T재반영근단신소관손해적진단개치우우기타지표,능경호지대근단신소관공능진행조기판단,대신장질병진치급예후고계구유중요의의.
Objective To investigate the value of urinary trehalase (T) in patients with renal proximal tubular damage.Methods 134 patients with kidney disease (male:66 female:68 age:18-59 ; 31cases with acute renal failure,30 cases with chronic renal failure,20 cases with drug-induced renal impairment,21 cases with renal transplantation and 32 cases with nephritic syndrome) and 101 healthy controls (58 males and 43 females) were selected.Urinary T,N-acetyl-D-glucosaminidase (NAG),β2-MG,gamma-glutamyl transferase (GGT) were detected.Data were analyzed by SPSS 11.5,including nonparametric rank test,ROC analysis.Results The level of urinary trehalase in control group was normally distributed (7.1 ± 4.1) μmol/h · g Cr (0-25 μmol/h · g Cr).There was no significant difference between men and women (t =0.63,P =0.53).Urinary T levels were significant higher in all kidney disease groups than in control group (Z =6.80,5.90,5.23,6.00,8.04,P ＜0.01).According to ROC curve,the area of urinary T under the ROC curve (AUC) in 134 patients was 0.9,significantly different with NAG,β2-MG,GGT area (P ＜ 0.01),the AUCs of T were 0.94,0.85,0.90,0.90,0.91 in acute and chronic renal failure group,drug-induced renal impairment group,renal transplantation group and nephritic syndrome group,respectively; Youden index were 0.85,0.65,0.77,0.66,0.72 respectively.Corresponding to the Youden index,sensitivity and specificity were 90.3％ and 95.1％,73.3％ and 92.1％,85.0％ and 92.1％,81.0％ and 85.2％,87.5％ and 84.2％ respectively.Conclusions The Urinary trehalase is better than other markers in the diagnosis of the proximal renal tubular damage.It was better to evaluate the proximal tubular function early in time.The diagnostic value of urinary trehalase played a key role in diagnosis,treatment and prognosis of kidney diseases.