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目的探讨氧化应激相关指标在慢性肾脏病(CKD)早期诊断和病情评估中的价值。方法选择2014年8月—2015年12月在浙江大学医学院附属第二医院肾脏内科住院治疗的CKD患者220例,选择2015年12月在该医院体检正常的100人作为对照。分别测定两组血清肌酐(Cr)、尿酸(UA)、γ-谷氨酰转肽酶(GGT)、同型半胱氨酸(HCY)水平,并比较两组差异。根据Cr水平,估算肾小球滤过率(GFR),划定CKD临床分期。采用受试者工作特征(ROC)曲线比较CKD I、CKD II组患者和对照组UA、GGT、HCY单项检测及3项联合检测的准确性。结果 CKD组血清Cr、UA、GGT、HCY水平均高于对照组(P<0.05),在CKD组与对照组的鉴别诊断研究中,UA、GGT、HCY单项和3项联合检测的ROC曲线下面积(AUC)值分别为0.823、0.585、0.850和0.924,单项临床诊断价值均低于3项联合(P<0.05)。在CKDⅠ组与对照组的鉴别诊断研究中,UA、GGT、HCY单项和3项联合检测的AUC值分别为0.711、0.594、0.716和0.807,单项临床诊断价值均低于3项联合(P<0.05)。在CKDⅠ组与Ⅱ组的鉴别诊断研究中,3项联合检测的AUC值为0.834,与HCY单项检测的AUC值0.828相比,差异无统计学意义(P>0.05)。结论 UA、GGT、HCY 3项指标的联合检测在CKD早期临床诊断中具有较高的应用价值,在CKD晚期单独检测HCY与3项联合检测的诊断价值相近。
Objective To investigate the value of oxidative stress related indicators in the early diagnosis and assessment of chronic kidney disease (CKD). Methods A total of 220 CKD patients hospitalized in Department of Nephrology, Second Affiliated Hospital of Zhejiang University from August 2014 to December 2015 were selected as the control group. The levels of serum creatinine (Cr), uric acid (UA), γ-glutamyl transpeptidase (GGT) and homocysteine (HCY) were measured in the two groups. According to Cr levels, estimated glomerular filtration rate (GFR), designated CKD clinical stage. The receiver operating characteristic (ROC) curve was used to compare the accuracy of single detection of UA, GGT and HCY in patients with CKD I and CKD II and the control group with three combined tests. Results The serum levels of Cr, UA, GGT and HCY in CKD group were significantly higher than those in control group (P <0.05). In the differential diagnosis study between CKD group and control group, the ROC curves of UA, GGT, HCY single and 3 combined tests The area (AUC) values were 0.823, 0.585, 0.850 and 0.924, respectively. The clinical diagnostic value of each item was less than 3 items (P <0.05). In the differential diagnosis study of CKD Ⅰ group and control group, the AUC values of single and combined test of UA, GGT and HCY were 0.711, 0.594, 0.716 and 0.807, respectively, and the clinical diagnostic value of single item was lower than that of 3 items (P <0.05) ). In the differential diagnosis study between CKD Ⅰ and Ⅱ group, the AUC value of 3 combined tests was 0.834, which was not significantly different from that of HCY single test (0.828) (P> 0.05). Conclusion The combined detection of UA, GGT and HCY indicators has high value in the early diagnosis of CKD. The value of HCY alone in the later stage of CKD is similar to that of the three combined tests.