练小芬 温彩银

[摘要]目的 评价尿微量清蛋白（Um-Alb）/尿肌酐（UREA）比值（ACR）、胱抑素C（Cys-C）、同型半胱氨酸（HCY）水平对高血压肾病早期的诊断价值。方法 选取2015年6月～2017年6月我院肾内科及心内科治疗的高血压肾病患者及高血压无明显肾病的患者各50例，分别为观察组和对照组，同时纳入50例同期健康体检者为健康组。比较各组ACR 、血清Cys-C、HCY水平；通过灵敏度、特异度、受检者工作特征曲线下面积（AUC）评价其对高血压肾病早期的诊断价值。结果 观察组ACR、Cys-C、HCY水平高于对照组及健康组，差异有统计学意义（P<0.05）。对照组ACR、Cys-C、HCY水平高于健康组，差异有统计学意义（P<0.05）。三者联合检测的灵敏度均显著高于单独检测（P<0.05）；特异度与单独检测比较，差异无统计学意义（P>0.05）；三者联合检测AUC均>单独检测，差异均有统计学意义（P<0.05）。结论 高血压肾病早期患者ACR、Cys-C、HCY水平高表达，三者联合检测在高血压肾病的早期诊断中有重要的作用。

[关键词]高血压肾病；尿微量清蛋白/尿肌酐比值；胱抑素C；同型半胱氨酸

[中图分类号] R544.1 [文献标识码] A [文章编号] 1674-4721（2018）11（c）-0146-03

[Abstract] Objective To investigate the diagnostic value of ACR， serum Cys-C and HCY in the diagnosis of early stage hypertensive nephropathy. Methods All of 100 cases of patients were selected from June 2015 to June 2017 in our hospital， including 50 patients with hypertensive nephropathy as observation group， and 50 patients with high blood pressure without obvious kidney damage as control group. Additionally， 50 healthy persons were selected as health group. The levels of ACR， Cys-C， HCY， were detected and compared among the three groups. The sensitivity， specificity and area under receiver operating characteristic curve （AUC） were calculated to assess the diagnostic value of ACR， Cys-C and HCY level. Results The levels of ACR， Cys-C and HCY in the observation group were higher than those in the control group and the healthy group， the differences were statistically significant （P<0.05）. The levels of ACR， Cys-C and HCY in the control group were higher than those in the healthy group， the differences were statistically significant （P<0.05）. The sensitivity of the combined detection was significantly higher than that of the individual detection （P<0.05）. There was no statistically significant differences between specificity and individual detection （P>0.05）. The AUC of combined detection was greater than that of independent detection， and the difference was statistically significant （P<0.05）. Conclusion The levels of ACR Cys-C and HCY are higher in early patients with hypertensive nephropathy. The combined detection plays an important role in the early diagnosis of hypertensive nephropathy.

[Key words] Hypertensive nephropathy； Urinary microalbumin； Cystatin C； Homocysteine

高血壓肾病是原发性高血压引起的微血管并发症，主要病理改变是肾小球动脉硬化，引起慢性肾功能不全，最终需要透析治疗或肾移植。高血压肾病已经成为威胁高血压患者生命健康的主要原因。高血压肾病早期无显著的病理改变和临床症状，发现时疾病已经进入进展期，治疗效果不佳[1]。因此，早期诊断、及时治疗是高血压肾病治疗的首要原则，可有效延缓疾病进展，保证患者生活质量[2]。尿微量清蛋白（Um-Alb）/尿肌酐（UREA）比值（ACR）、血清胱抑素C（Cys-C）和同型半胱氨酸（HCY）均是反应肾脏损伤的有效指标，但其在高血压肾病早期诊断中的价值还存在一定争议。本研究探讨ACR、Cys-C和HCY的单独及联合检测在高血压肾病早期诊断中的价值，现报道如下。

1 资料与方法

1.1一般资料