Price Christopher P, Newall Ronald G, Boyd James C
Diagnostics Division, Bayer Healthcare, Newbury, United Kingdom.
Clin Chem. 2005 Sep;51(9):1577-86. doi: 10.1373/clinchem.2005.049742. Epub 2005 Jul 14.
Proteinuria is recognized as an independent risk factor for cardiovascular and renal disease and as a predictor of end organ damage. The reference test, a 24-h urine protein estimation, is known to be unreliable. A random urine protein:creatinine ratio has been shown to correlate with a 24-h estimation, but it is not clear whether it can be used to reliably predict the presence of significant proteinuria.
We performed a systematic review of the literature on measurement of the protein:creatinine ratio on a random urine compared with the respective 24-h protein excretion. Likelihood ratios were used to determine the ability of a random urine protein:creatinine ratio to predict the presence or absence of proteinuria.
Data were extracted from 16 studies investigating proteinuria in several settings; patient groups studied were primarily those with preeclampsia or renal disease. Sensitivities and specificities for the tests ranged between 69% and 96% and 41% and 97%, respectively, whereas the positive and negative predictive values ranged between 46% and 95% and 45% and 98%, respectively. The positive likelihood ratios ranged between 1.8 and 16.5, and the negative likelihood ratios between 0.06 and 0.35. The cumulative negative likelihood ratio for 10 studies on proteinuria in preeclampsia was 0.14 (95% confidence interval, 0.09-0.24).
The protein:creatinine ratio on a random urine specimen provides evidence to "rule out" the presence of significant proteinuria as defined by a 24-h urine excretion measurement.
蛋白尿被认为是心血管和肾脏疾病的独立危险因素以及终末器官损害的预测指标。已知作为参考检测的24小时尿蛋白定量并不可靠。随机尿蛋白与肌酐比值已被证明与24小时尿蛋白定量相关，但尚不清楚其是否可用于可靠预测显著蛋白尿的存在。
我们对随机尿蛋白与肌酐比值测定与相应24小时尿蛋白排泄量的文献进行了系统评价。似然比用于确定随机尿蛋白与肌酐比值预测蛋白尿存在与否的能力。
从16项在多种情况下研究蛋白尿的研究中提取数据；所研究的患者群体主要是先兆子痫或肾脏疾病患者。这些检测的敏感性和特异性分别在69%至96%和41%至97%之间，而阳性和阴性预测值分别在46%至95%和45%至98%之间。阳性似然比在1.8至16.5之间，阴性似然比在0.06至0.35之间。关于先兆子痫蛋白尿的10项研究的累积阴性似然比为0.14（95%置信区间，0.09 - 0.24）。
随机尿标本中的蛋白与肌酐比值为“排除”24小时尿排泄量所定义的显著蛋白尿的存在提供了证据。
