尿血肌酐比值与慢性肾衰竭临床分期-南通大学附属医院内分泌代谢科.docVIP

尿、血肌酐比值与慢性肾衰竭临床分期* 杨建军 崔世维 顾志峰 朱晓晖 朱静仪 （南通大学附属医院，江苏 南通 226001） *南通大学自然科学科研项目，项目编号LC2005－03 摘要 目的 探讨慢性肾衰竭(CRF)临床分期的简易方法。方法①测定慢性肾衰竭患者的内生肌酐清除率(Ccr)。在尿浓缩状态下，测定尿肌酐浓度(Ucr)和血清肌酐的浓度(Scr)，得出两者的比值Ucr/Scr。分析Ccr与Ucr/Scr的相关性。②根据Ucr/Scr95％可信区间推算Ucr/Scr分期标准，并验证其敏感性和特异性。结果 ①Ccr与Ucr/Scr有很高的相关性(r=0.9067, P0.01)。②Ucr/Scr分期标准的敏感性（0.8681）和特异性（0.8406）都较高。结论Ucr/Scr可作为肾小球滤过率检测的指标，并可以作为CRF分期的指标。 关键词 慢性肾衰竭；内生肌酐清除率；尿肌酐浓度；血清肌酐浓度 Chronic Renal Failure Stages and Ratio between Urine and Serum Creatinine Yang Jian-jun, Cui Shi-wei, Zhu Xiao-hui, et al. Affiliated Hospital of Nantong University, Nantong 225001, China Abstract Objective To investigate a simple way to mensurate glomerular filtration rate(GFR). Methods ①Endogenous creatinine clearance rate (Ccr) of chronic renal failure(CRF) patients was mensurated. Urine creatinine(Ucr) and serum creatinine(Scr) was mensurated when urine was concentrated. The ratio(Ucr/Scr) between Ucr and Scr was compared with Ccr. ②The standard of Ucr/Scr was acquired according to 95％ confidence interval. The standard was validated by its speciality and sensitivity. Results ① The relativity of them was significant (r=0.9067, P0.01). ② The sensitivity(86.81％)and speciality(84.06％) was both high. Conclusions Ucr/Scr can be regarded as the examination marker of GFR and the stages of CRF. Key words CRF; Ccr; Ucr; Scr 肾小球滤过率(glomerular filtration rate, GFR)检测的方法较多，其中较准确的有菊粉清除率、内生肌酐清除率(endogenous creatinine clearance rate,Ccr)和99mTc二乙三胺五醋酸法(99mTc-DTPA)等，但是都很繁琐、费时，或者价格昂贵。经过研究，我们发现一种简易、方便又经济的检测方法，即尿肌酐浓度(urine creatinine, Ucr)与血清肌酐浓度(serum creatinine, Scr)的比值（Ucr/Scr）可替代Ccr作为GFR的检测指标[1]。 1 资料与方法 1.1样本选择及分期标准 正常对照组为本院内科无肾功能损害的住院患者。肾功能损害组为本院肾内科慢性肾衰竭不同分期的住院患者。慢性肾衰竭的分期依据内科学第六版[2]，按病人的症状、血清尿素氮（blood urea nitrogen, BUN）、Scr、Ccr等分为四期：肾贮备能力下降期、氮质血症期、肾衰竭期、尿毒症期。排除糖尿病及使用利尿剂等影响尿生成药物的样本。 1.2检测方法 Ccr的检测方法[3]：受试者连续素食3天，避免剧烈运动，于第4天晨8时将尿液排净，然后收集24小时尿量。留取静脉血2ml，测Scr、Ucr，计算Ccr。Ucr/Scr的检测方法：受试者当晚10时至次日晨6时禁水，次日晨6时左右弃去第一次尿液，7时左右留取第二次的尿液送检，同时留取静脉血2 ml，测Ucr、Scr，计算Ucr/Scr。 1.3 正常对照及慢性肾衰竭