尿蛋白/肌酐比值可准确估计 IgA 肾病患者的 24 小时尿蛋白，但不能准确估计膜性肾病患者的 24 小时尿蛋白。
Spot urine protein/creatinine ratio as a reliable estimate of 24-hour proteinuria in patients with immunoglobulin A nephropathy, but not membranous nephropathy.
机构信息
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan.
出版信息
BMC Nephrol. 2019 Aug 6;20(1):306. doi: 10.1186/s12882-019-1486-8.
BACKGROUND
Proteinuria is known to be associated with both kidney function deterioration and cardiovascular diseases. While proteinuria estimation from 24-h urine samples has traditionally been considered as the standard method for assessment of the degree of urinary protein excretion, sample collection is associated with several technical problems such as inaccurate collection and the potential spread of drug-resistant pathogens. Therefore, the spot urine protein/creatinine ratio (PCR) assessment is currently recommended as an alternative. While the utility of PCR has been validated, studies on the association between spot urine PCR and 24-h proteinuria (24HP) in patients with chronic glomerular nephritis (CGN) and nephrotic syndrome (NS) are limited. This study aimed to evaluate whether an estimated result from a spot urine PCR could sufficiently approximate the daily urine protein excretion amount from a 24-h urine sample in patients with immunoglobulin A nephropathy (IgAN), minimal change disease (MCD), and membranous nephropathy- nephrotic syndrome (MN-NS).
METHODS
The study participants included 161 patients with IgAN, MCD, or MGN-NS at the Jikei University Kashiwa Hospital and Kanagawa Prefecture Shiomidai Hospital. The correlation between spot urine PCR and a 24-h urine protein was investigated using linear regression analysis with Spearman's correlation (r) coefficient and intraclass correlation coefficient (ICC).
RESULTS
While high correlation coefficients (r = 0.86, P < 0.001) and substantial agreement (ICC: 0.806, P < 0.001) were observed in patients with IgAN, similar correlations were not observed in patients with MCD or MN-NS. In the patients with MCD, r was 0.53 (P < 0.001), which signified a slight correlation, and in the patients with MN-NS, r was 0.289 (P = 0.17), which was not statistically significant.
CONCLUSIONS
This study revealed that spot urine PCR is a reliable estimate of 24HP value in patients with IgAN. In contrast, there is a considerable difference between the daily urine protein excretion amount based on a 24-h urine sample and that which is calculated from spot urine PCR in patients with NS.
背景
蛋白尿与肾功能恶化和心血管疾病均有关联。虽然 24 小时尿液样本中的蛋白尿估计一直被认为是评估尿蛋白排泄程度的标准方法，但样本采集存在一些技术问题，例如采集不准确和潜在的耐药病原体传播。因此，目前推荐使用尿液蛋白/肌酐比值（PCR）评估作为替代方法。虽然 PCR 的实用性已经得到验证，但在慢性肾小球肾炎（CGN）和肾病综合征（NS）患者中，关于尿液 PCR 与 24 小时蛋白尿（24HP）之间关联的研究有限。本研究旨在评估在 IgA 肾病（IgAN）、微小病变性肾病（MCD）和膜性肾病-肾病综合征（MN-NS）患者中，尿液 PCR 的估算结果是否能充分近似于 24 小时尿液样本中的每日尿蛋白排泄量。
方法
本研究纳入了在日本帝京大学柏医院和神奈川县下総台医院就诊的 161 例 IgAN、MCD 或 MGN-NS 患者。使用 Spearman 相关系数（r）和组内相关系数（ICC）进行线性回归分析，研究了尿液 PCR 与 24 小时尿液蛋白之间的相关性。
结果
在 IgAN 患者中，观察到高相关系数（r=0.86，P<0.001）和高度一致性（ICC：0.806，P<0.001），但在 MCD 或 MN-NS 患者中未观察到类似的相关性。在 MCD 患者中，r 为 0.53（P<0.001），表明存在轻度相关性，在 MN-NS 患者中，r 为 0.289（P=0.17），无统计学意义。
结论
本研究表明，尿液 PCR 是 IgAN 患者 24HP 值的可靠估计方法。相比之下，在 NS 患者中，基于 24 小时尿液样本的每日尿蛋白排泄量与通过尿液 PCR 计算得出的量之间存在较大差异。
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