摘要
目的探讨血清肌酐(Scr)与前清蛋白(PA)比值(Scr/PA)在心力衰竭(HF)并发肾衰竭(肾衰)诊断及预后评估中的应用价值。方法回顾性分析恩施土家族苗族自治州中心医院2022年1月至2023年10月收治的120例HF患者的临床资料,根据是否并发肾衰分为无肾衰组(单纯HF患者,60例)与并发肾衰组(HF并发肾衰患者,60例),比较2组患者的一般资料、Scr与PA水平,并计算Scr/PA。以临床诊断结果为金标准,分析Scr/PA对HF并发肾衰的诊断效能,比较并发肾衰组治疗前后及不同预后情况患者的相关指标。结果并发肾衰组估算的肾小球滤过率(eGFR)低于无肾衰组,Scr水平与Scr/PA高于无肾衰组,PA水平低于无肾衰组,差异均有统计学意义(P<0.05)。Scr、PA及Scr/PA对HF并发肾衰的阳性检出率均略低于临床诊断结果。Scr/PA诊断HF并发肾衰的灵敏度为84.44%、特异度为93.33%、准确率为90.00%,其灵敏度与准确率均高于Scr、PA,差异有统计学意义(P<0.05)。Scr、PA及Scr/PA的特异度比较,差异无统计学意义(P>0.05)。治疗后,并发肾衰组患者Scr/PA低于入院当天,eGFR高于入院当天,差异均有统计学意义(P<0.05);治疗前并发肾衰组患者Scr/PA与eGFR水平呈负相关(r=-0.432,P<0.05)。治疗后,并发肾衰组预后不良患者Scr水平、Scr/PA高于预后良好患者,PA水平低于预后良好组,差异均有统计学意义(P<0.05)。结论Scr/PA对HF并发肾衰的诊断效能较佳,具有较高的灵敏度与准确率,还可用于评估患者的预后情况。临床在HF患者治疗过程中有必要加强对Scr/PA的监测,以便尽早发现异常并采取相应的预防性措施,为患者提供更多安全保障。
Objective To investigate the application value of the serum creatinine-to-prealbumin ratio(Scr/PA ratio)in the diagnosis and prognostic evaluation of heart failure(HF)complicated with renal failure.Methods A retrospective analysis was conducted on clinical data from 120 patients with HF admitted to Enshi Tujia and Miao Autonomous Central Hospital from January 2022 to October 2023.Patients were categorized into the non-renal failure group(HF alone,60 cases)and renal failure group(HF complicated with renal failure,60 cases)based on the presence of renal failure.Baseline characteristics,serum creatinine(Scr)and prealbumin(PA)levels were compared between the two groups,and the Scr/PA ratio was calculated.Using clinical diagnosis as the gold standard,the diagnostic performance of the Scr/PA ratio for HF complicated with renal failure was analyzed.Relevant indicators were compared pre-and post-treatment and among patients with different prognostic outcomes in the renal failure group.Results The estimated glomerular filtration rate(eGFR)in the renal failure group was lower than that in the non-renal failure group,while Scr level and the Scr/PA ratio were higher than those in the non-renal failure group,and the PA level was lower than that in the non-renal failure group,with all differences being statistically significant(P<0.05).The positive detection rates of Scr,PA and the Scr/PA ratio for HF with renal failure were slightly lower than those of clinical diagnosis.The sensitivity,specificity and accuracy of the Scr/PA ratio for diagnosing HF combined with renal failure were 84.44%,93.33%and 90.00%respectively,with both sensitivity and accuracy being higher than Scr and PA,and these differences were statistically significant(P<0.05).There were no significant differences in specificity among Scr,PA and the Scr/PA ratio(P>0.05).After treatment,the Scr/PA ratio in the renal failure group was significantly lower than the baseline level,whereas eGFR was significantly increased,with both differences being statistically significant(P<0.05).The Scr/PA ratio before treatment in patients with concurrent renal failure was significantly negatively correlated with eGFR level(r=-0.432,P<0.05).In the renal failure group,the post-treatment Scr level and the Scr/PA ratio were significantly higher,while the PA level was markedly lower in patients with poor prognoses compared with those with favorable outcomes,with statistically significant differences(P<0.05).Conclusion The Scr/PA ratio demonstrates strong diagnostic efficacy for HF complicated by renal failure,with high sensitivity and accuracy,and serves as a prognostic indicator.Clinically,close monitoring of the Scr/PA ratio in HF patients is imperative to detect abnormalities early and implement preventive interventions,thereby enhancing patient safety.
作者
宋秋玲
张杰
李世强
徐任利
周红术
王海庆
SONG Qiuling;ZHANG Jie;LI Shiqiang;XU Renli;ZHOU Hongshu;WANG Haiqing(Department of Medical Laboratory,Enshi Tujia and Miao Autonomous Central Hospital,Enshi,Hubei 445000,China;Department of Laboratory Medicine,Second People′s Hospital of Yichang,Yichang,Hubei 443008,China)
出处
《检验医学与临床》
2025年第11期1520-1524,共5页
Laboratory Medicine and Clinic
基金
湖北省卫生健康委员会面上项目(WJ2023M155)。
关键词
心力衰竭
肾衰竭
肌酐
前清蛋白
估算的肾小球滤过率
灵敏度
特异度
heart failure
renal failure
creatinine
prealbumin
estimated glomerular filtration rate
sensitivity
specificity
