摘要
目的分析外加葡萄糖实验对慢性肾脏病(CKD)患者尿肌酐相关肾损伤标志物的干扰。方法本研究采用横断面研究。选取2023年10月1日至2024年3月31日于北京大学第一医院就诊的CKD患者,年龄为(50±18)岁,男性患者90例,女性患者70例。收集患者的新鲜晨尿,纳入160份尿液样本。将尿液样本分成5份,每份225μl,其中1份加入75μl去离子水作为对照样本,其余各加入120、480、960、1200 mmol/L葡萄糖溶液75μl,最终得到葡萄糖浓度分别为30、120、240、300 mmol/L的尿液样本。分别使用酶法和苦味酸法测定每份样本的尿肌酐,并计算尿白蛋白-肌酐比值(uACR)、尿蛋白-肌酐比值(uPCR)、尿转铁蛋白-肌酐比值(uTRF/uCr)、尿α1-微球蛋白-肌酐比值(uA1M/uCr)、尿免疫球蛋白G-肌酐比值(uIgG/uCr)、尿N-乙酰葡萄糖苷酶-肌酐比值(uNAG/uCr)。结果在高葡萄糖浓度条件下,酶法与苦味酸法在检测尿肌酐相关肾损伤标志物时存在显著差异(P<0.05)。葡萄糖浓度为30、120、240、300 mmol/L时,酶法肌酐的平均百分偏差为-0.19%、-0.27%、-0.20%、-0.21%;苦味酸法肌酐的平均百分偏差为0.78%、1.26%、1.35%、1.38%,随着葡萄糖浓度的增加,加糖前后测定结果的偏差逐渐增大。酶法测定uACR的平均绝对偏差为-0.01、1.27、0.95、1.10 mg/g;苦味酸法测定uACR的平均绝对偏差为-11.69、-14.98、-16.91、-18.51 mg/g,明显高于酶法且平均偏差的绝对值随葡萄糖浓度升高而增大。对于uPCR、uTRF/uCr、uA1M/uCr、uNAG/uCr、uIgG/uCr,酶法测定的偏差均小于苦味酸法测定的偏差。结论酶法肌酐及相关肾损伤标志物测定受葡萄糖浓度的影响较小,苦味酸法肌酐及相关肾损伤标志物测定结果受葡萄糖浓度影响较大。
ObjectiveTo analyze the interference of an exogenous glucose test on urinary creatinine-related renal injury biomarkers in patients with chronic kidney disease(CKD).MethodsThis cross-sectional study enrolled CKD patients who visited Peking University First Hospital between October 2023 and March 2024.The patients(age:50±18 years)included 90 males and 70 females.Fresh morning urine samples were collected,totaling 160 samples.Each urine sample was divided into 5 aliquots,each containing 225μl.One aliquot received 75μl of deionized water as the control.The other aliquots received 75μl of glucose solutions at concentrations of 120,480,960,and 1200 mmol/L,resulting in final glucose concentrations of 30,120,240,and 300 mmol/L in the urine samples,respectively.Urinary creatinine in each sample was measured using both the enzymatic method and the picric acid(Jaffe)method.The following ratios were calculated:urinary albumin-to-creatinine ratio(uACR),urinary protein-to-creatinine ratio(uPCR),urinary transferrin-to-creatinine ratio(uTRF/uCr),urinaryα1-microglobulin-to-creatinine ratio(uA1M/uCr),urinary immunoglobulin G-to-creatinine ratio(uIgG/uCr),and urinary N-acetyl-β-D-glucosaminidase-to-creatinine ratio(uNAG/uCr).ResultsUnder high glucose concentrations,significant differences(P<0.05)were observed between the enzymatic method and the picric acid method in measuring urinary creatinine-related renal injury biomarkers.At glucose concentrations of 30,120,240,and 300 mmol/L,the mean percentage biases for creatinine measured by the enzymatic method were-0.19%,-0.27%,-0.20%,and-0.21%,respectively.The mean percentage biases for creatinine measured by the picric acid method were 0.78%,1.26%,1.35%,and 1.38%,respectively,showing an increasing deviation between the results before and after glucose addition as the glucose concentration rose.For uACR measurement,the mean absolute biases using the enzymatic method were-0.01,1.27,0.95,and 1.10 mg/g at the respective glucose concentrations.Using the picric acid method,the mean absolute biases for uACR were-11.69,-14.98,-16.91,and-18.51 mg/g.The biases of the picric acid method were significantly higher than the those of the enzymatic method,and the absolute value of the mean biases increased with rising glucose concentration.For uPCR,uTRF/uCr,uA1M/uCr,uNAG/uCr,and uIgG/uCr,the deviations measured by the enzymatic method were consistently smaller than those measured by the picric acid method.ConclusionsThe measurement of creatinine and related renal injury biomarkers by the enzymatic method is less affected by glucose concentration.In contrast,the measurement results obtained using the picric acid method are significantly affected by glucose concentration.
作者
过静静
李海霞
董捷
闫存玲
李涛
杜佳琳
安崇文
逄璐
Guo Jingjing;Li Haixia;Dong Jie;Yan Cunling;Li Tao;Du Jialin;An Chongwen;Pang Lu(Department of Clinical Laboratory,Peking University First Hospital,Beijing 100034,China;Department of Nephrology,Peking University First Hospital,Beijing 100034,China)
出处
《中华检验医学杂志》
北大核心
2025年第8期1063-1070,共8页
Chinese Journal of Laboratory Medicine
基金
北京市自然科学基金(7244418)。
关键词
尿糖
尿肌酐
苦味酸法
酶法
尿液肾损伤标志物
Glycosuria
Urine creatinine
Jaffe method
Enzymatic method
Urinary renal injury markers
