单次晨尿检测男性肾脏尿酸排泄不足的诊断准确性

Diagnostic Accuracy of Single Spot Urine for Detecting Renal Uric Acid Underexcretion in Men.

作者信息

Sakane Naoki, Okuno Ayana, Nomaguchi Kouji, Tanaka Miyuki, Abe Fumiaki, Kakiuchi Izumi, Kiyosawa Kyoko, Miyasaka Mitsunaga, Nakamura Masahiko

机构信息

Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.

Food Ingredients & Technology Institute, R&D Division, Moringa Milk Insustry Co., Ltd. Kanagawa, Japan.

出版信息

J Clin Med Res. 2020 Jul;12(7):443-447. doi: 10.14740/jocmr4250. Epub 2020 Jun 25.

DOI:10.14740/jocmr4250

PMID:32655739

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7331867/

Abstract

BACKGROUND

The uric acid (UA) clearance test to evaluate the hyperuricemia phenotype requires a great deal of time. However, the utility of single spot urine is scarce. The study aimed to determine the diagnostic accuracy of single spot urine for predicting renal UA underexcretion (the decreased UA excretion) in men.

METHODS

A total of 73 male participants aged 20 - 74 years with a UA level of 6.0 - 7.9 mg/dL were enrolled in the study. Renal UA underexcretion was defined as < 7.3 mL/min using the 60-min method. Urinary UA to creatinine ratio (UACR), fractional clearance of urate (FCU), and the Simkin index were calculated. A receiver operating characteristic (ROC) analysis was performed to compare the diagnostic utility of these parameters for predicting UA underexcretion.

RESULTS

In the ROC analysis, the area under the curve values of the UACR, FCU, and the Simkin index for predicting UA underexcretion were 0.903 (95% confidence interval (CI): 0.830 - 0.976), 0.841 (95% CI: 0.749 - 0.933), and 0.779 (95% CI: 0.673 - 0.885), respectively. An optimal UACR cutoff of 0.460 (sensitivity 89.2%, specificity 80.6%, overall diagnostic accuracy 84.9%, positive predictive value 82.5%, and negative predictive value 87.9%) was identified.

CONCLUSIONS

These results suggest that the UACR is a simple and efficient test with high sensitivity and specificity levels for predicting renal UA underexcretion in men.

摘要

背景

用于评估高尿酸血症表型的尿酸（UA）清除试验需要大量时间。然而，单次随机尿样的实用性尚少。本研究旨在确定单次随机尿样对预测男性肾脏尿酸排泄不足（尿酸排泄减少）的诊断准确性。

方法

本研究共纳入73名年龄在20 - 74岁之间、尿酸水平为6.0 - 7.9 mg/dL的男性参与者。采用60分钟法将肾脏尿酸排泄不足定义为<7.3 mL/分钟。计算尿尿酸与肌酐比值（UACR）、尿酸分数清除率（FCU）和辛金指数。进行受试者工作特征（ROC）分析，以比较这些参数对预测尿酸排泄不足的诊断效用。

结果

在ROC分析中，UACR、FCU和辛金指数预测尿酸排泄不足的曲线下面积值分别为0.903（95%置信区间（CI）：0.830 - 0.976）、0.841（95% CI：0.749 - 0.933）和0.779（95% CI：0.673 - 0.885）。确定最佳UACR临界值为0.460（敏感性89.2%，特异性80.6%，总体诊断准确性84.9%，阳性预测值82.5%，阴性预测值87.9%）。