血清HE4在慢性肾脏疾病分期中的诊断价值
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摘要
目的研究血清人附睾蛋白-4 (HE4)在慢性肾脏疾病(chronic kidney disease,CKD)不同临床分期的变化规律,探讨HE4在CKD临床分期的诊断价值。方法收集本院2016年2月至2017年2月住院的CKD患者143例和健康体检者140例,采用化学发光法测定HE4,全自动生化分析仪检测肌酐(CREA)、尿素(UREA)、胱抑素C (Cys C)、尿酸(URIC),并进行相关性比较,同时根据受试者工作特征曲线(ROC)分析HE4的诊断价值。结果 CKD患者的HE4、UREA、CREA、Cys C、URIC水平与正常对照组比较差异具有统计学意义(P <0. 05)。CKD患者不同分期之间除了血清URIC水平以外其他血清HE4、Cys C、CREA和UREA水平差异具有统计学意义(P<0.05),血清HE4、Cys C、CREA、UREA,ROC曲线面积均>0.9,但HE4曲线下面积均大于Cys C、UREA、CREA、URIC等项目。结论 血清HE4在诊断CKD中具有较高的辅助诊断价值,其结果与CKD的严重程度呈正相关,从而有利于判断CKD的分期。
Objective To investigate the diagnostic value of human epididymis protein 4(HE4) in different stages of chronic kidney disease(CKD) patients. Methods Serum samples were collected from 143 CKD patients with different clinical stages and 140 healthy controls between February 2016 and February 2017 in our hospital. Chemiluminescence method was used to assay the levels of serum human epididymis protein 4(HE4) and automatic biochemical analyzer was used to detect the serum levels of Urea, creatinine(CREA),cystatin C(Cys C)and URIC acid(URIC). Then the correlation analysis was performed between levels of HE4 and these biochemical indicators, and receiver-operating characteristic curve(ROC) was established to evaluate the diagnostic value of HE4. Results The differences of serum HE4,Urea CREA,Cys C and URIC levels between CKD patients and the healthy controls were not significant( P < 0. 05). Serum HE4, Cys C,CREA and UREA levels of patients with different clinical stages were significantly different(P <0.05),but not the serum level of URIC(P >0. 05). The area under curve(AUC) of HE4 was the largest in all five indicators,though they were all higher than 0. 9. Conclusion Serum level of HE4 is valuable for diagnosing the CKD. HE4 level has a positive correlation with the clinical stages, which can benefit the clinical stages judgment.
Objective To investigate the diagnostic value of human epididymis protein 4(HE4) in different stages of chronic kidney disease(CKD) patients. Methods Serum samples were collected from 143 CKD patients with different clinical stages and 140 healthy controls between February 2016 and February 2017 in our hospital. Chemiluminescence method was used to assay the levels of serum human epididymis protein 4(HE4) and automatic biochemical analyzer was used to detect the serum levels of Urea, creatinine(CREA),cystatin C(Cys C)and URIC acid(URIC). Then the correlation analysis was performed between levels of HE4 and these biochemical indicators, and receiver-operating characteristic curve(ROC) was established to evaluate the diagnostic value of HE4. Results The differences of serum HE4,Urea CREA,Cys C and URIC levels between CKD patients and the healthy controls were not significant( P < 0. 05). Serum HE4, Cys C,CREA and UREA levels of patients with different clinical stages were significantly different(P <0.05),but not the serum level of URIC(P >0. 05). The area under curve(AUC) of HE4 was the largest in all five indicators,though they were all higher than 0. 9. Conclusion Serum level of HE4 is valuable for diagnosing the CKD. HE4 level has a positive correlation with the clinical stages, which can benefit the clinical stages judgment.
引文
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[11]马瑞宣,王萍,赵娜.血清肿瘤标志物在慢性肾脏病患者检测中的影响研究[J].临床医药文献电子杂志,2017,4(5):919.
[12] GALGANO M T, HAMPTON G M, FRIERSON H F. Comprehensive analysis of HE4 expression in normal and malignant human tissues[J].Mod Pathol,2006,19(6):847-853.
[13]贺艳光,仇燕,郭晓丽,等.慢性肾脏病患者血清人附睾分泌蛋白4与肾小球滤过率的相关性研究[J].山西医药杂志,2015,44(8):858-861.
[14] LeBLEU V S,TENG Y, O'CONNELL J T, et al. Identification of Human Epididymis Protein-4 as a Novel Fibroblast-Derived Mediator of Fibrosis[J]. Nat Med,2013,19(2):227-231.
[15] Susantitaphong P,Altamimi S,Ashkar M,et al. GFR at Initiation of Dialysis and Mortality in CKD:A Meta-analysis. Am J Kidney Dis,2012,59(6):829-840.
[16]吴萍,叶伟民,李晨,等.人附睾蛋白4对慢性肾脏疾病的诊断价值研究[J].检验医学,2015,30(5):461-464.
[17]袁腾飞,李艳,彭锐.人附睾蛋白4对慢性肾脏病的诊断价值[J].检验医学与临床,2017,14(5):599-603.
[2] STARR M C, HINGORANI S R. Prematurity and future kidney health:the growing risk of chronic kidney disease[J]. Curr Opin Pediatr,2018,30(2):228-235.
[3]李财昌,周萍,王顺,等重症医学科患者急性肾损伤的临床特点分析[J].新疆医科大学学报,2017,40(5):602-605.
[4]王承缙,姚智.血清HE4检测对妇科盆腔恶性肿瘤临床早期诊断价值的研究[J].中国实验诊断学,2013,17(5):929-931.
[5]郭继强.血清HE4和CA125联检在卵巢癌中的临床价值[J].放射免疫学杂志,2013,26(5):697-698.
[6] NAGY B Jr,KRASZNAI Z T, BALLA H, et al. Elevated human epididymis protein 4 concentrations in chronic kidney disease[J].Ann Clin Biochem,2012,49(Pt4):377-380.
[7] FERRARO S,PASQUALETTI S,CARNEVALE A,et al. Cystatin C provides a better estimate of the effect of glomerular filtration rate on serum human epididymis protein 4 concentrations[J]. Clin Chem Lab Med,2016,54(10):1629-1634.
[8]凡瞿明,卢小岚,王强,等.人附睾蛋白4评价慢性肾脏病患者肾功能的价值[J].临床检验杂志,2016,34(1):38-39,69.
[9]赖玮婧,刘芳,付平,等.慢性肾脏病评估及管理临床实践指南解读-从K/DOQI到KDIGO[J].中国实用内科杂志,2013,33(6):448-453.
[10]全国eGFR课题协作组.MDRD方程在我国慢性肾脏病患者中的改良和评估[J].中华肾脏病杂志,2006,22(10):589-595.
[11]马瑞宣,王萍,赵娜.血清肿瘤标志物在慢性肾脏病患者检测中的影响研究[J].临床医药文献电子杂志,2017,4(5):919.
[12] GALGANO M T, HAMPTON G M, FRIERSON H F. Comprehensive analysis of HE4 expression in normal and malignant human tissues[J].Mod Pathol,2006,19(6):847-853.
[13]贺艳光,仇燕,郭晓丽,等.慢性肾脏病患者血清人附睾分泌蛋白4与肾小球滤过率的相关性研究[J].山西医药杂志,2015,44(8):858-861.
[14] LeBLEU V S,TENG Y, O'CONNELL J T, et al. Identification of Human Epididymis Protein-4 as a Novel Fibroblast-Derived Mediator of Fibrosis[J]. Nat Med,2013,19(2):227-231.
[15] Susantitaphong P,Altamimi S,Ashkar M,et al. GFR at Initiation of Dialysis and Mortality in CKD:A Meta-analysis. Am J Kidney Dis,2012,59(6):829-840.
[16]吴萍,叶伟民,李晨,等.人附睾蛋白4对慢性肾脏疾病的诊断价值研究[J].检验医学,2015,30(5):461-464.
[17]袁腾飞,李艳,彭锐.人附睾蛋白4对慢性肾脏病的诊断价值[J].检验医学与临床,2017,14(5):599-603.