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血清胃泌素前体释放肽在慢性肾脏病中的临床意义与诊断价值

Clinical significance and diagnostic value of serum progastrin-releasing peptide in patients with chronic kidney diseases

    摘要
  • 摘要:
    目的 探讨血清胃泌素前体释放肽(proGRP)水平变化在慢性肾脏病(CKD)中的临床意义与诊断价值。
    方法 回顾性分析在肾内科住院的259例CKD患者的临床资料，按估算肾小球滤过率(eGFR)分期(CKD1~5期)将其中未接受透析治疗的167例患者分为5组，并按透析方式将接受透析治疗的92例患者分为2组(血液透析组和腹膜透析组)，另选取31例健康体检者纳入对照组。比较对照组与不同分期CKD组血清proGRP及肾脏病标志物水平，分析血清proGRP与血清肌酐、eGFR、尿素氮、尿酸、胱抑素C、血β2微球蛋白、血清白蛋白、血红蛋白的相关性，采用受试者工作特征(ROC)曲线计算血清proGRP预测患者eGFR < 60 mL/min发生(进展到CKD3期)的最佳截断值。
    结果 CKD3期组、CKD4期组、CKD5期组患者的血清proGRP水平高于对照组，差异有统计学意义(P＜0.05), 且随着CKD分期的增加，血清proGRP水平逐渐升高。血清proGRP与血清肌酐(r=0.910, P＜0.01)、eGFR(r=-0.917, P＜0.01)、尿素氮(r=0.881, P＜0.01)、尿酸(r=0.641, P＜0.01)、胱抑素C(r=0.919, P＜0.01)、血β2微球蛋白(r=0.855, P＜0.01)、血清白蛋白(r=-0.297, P＜0.01)和血红蛋白(r=-0.623, P＜0.01)均显著相关。ROC曲线分析显示，血清proGRP最佳截断值为67.20 pg/mL时，预测患者进展到CKD3期的灵敏度为84.1%，特异度为100.0%。血液透析组患者血清proGRP水平与腹膜透析组患者比较，差异无统计学意义(P>0.05)。
    结论 CKD患者血清proGRP水平相较于健康人群有所升高，且随着CKD分期的增加而逐渐升高，故血清proGRP水平可用于评估CKD病情的严重程度。血清proGRP与血清肌酐、尿素氮、尿酸、胱抑素C和血β2微球蛋白呈正相关，与eGFR、血清白蛋白和血红蛋白呈负相关。

     

    Abstract:
    Objective To investigate the clinical significance and diagnostic value of serum progastrin-releasing peptide(proGRP) in patients with chronic kidney diseases (CKD).
    Methods The clinical data of 259 hospitalized patients with CKD in the department of nephrology were retrospectively analyzed. A total of 167 patients without dialysis were divided into five groups according to estimated glomerular filtration rate (eGFR) staging (CKD stages 1 to 5), 92 patients receiving dialysis treatment were divided into two groups (hemodialysis group and peritoneal dialysis group) according to the way of dialysis, and another 31 healthy subjects were included in control group. The levels of serum proGRP and markers of kidney disease were compared between the control group and CKD groups with different stages, and the correlations of serum proGRP with serum creatinine, eGFR, urea nitrogen, uric acid, cystatin C, blood β2 microglobulin, serum albumin and hemoglobin were analyzed. The optimal cut-off value of serum proGRP for predicting occurrence of eGFR < 60 mL/min (progression to CKD3) was calculated by receiver operating characteristic (ROC) curve.
    Results The serum proGRP levels of patients in the CKD3 stage group, the CKD4 stage group and the CKD5 stage group were higher than those in the control group(P < 0.05), and the serum proGRP levels gradually increased with the increase of CKD stage. Serum proGRP was significantly correlated with serum creatinine (r=0.910, P < 0.01), eGFR (r=-0.917, P < 0.01), urea nitrogen (r=0.881, P < 0.01), serum uric acid (r=0.641, P < 0.01), cystatin C (r=0.919, P < 0.01), serum β2 microglobulin (r=0.855, P < 0.01), serum albumin (r=-0.297, P < 0.01) and hemoglobin (r=-0.623, P < 0.01). ROC curve analysis showed that when the optimal cut-off value of serum proGRP was 67.20 pg/mL, the sensitivity and specificity of predicting CKD3 stage was 84.1% and 100.0%. There was no significant difference in serum proGRP level between the hemodialysis group and the peritoneal dialysis group (P>0.05).
    Conclusion Serum proGRP levels in patients with CKD are higher than those in healthy subjects, and are increased with the increase of CKD stages, thus serum proGRP level can be used to evaluate the severity of CKD. Serum proGRP is positively correlated with serum creatinine, urea nitrogen, uric acid, cystatin C and β2 microglobulin, while is negatively correlated with eGFR, serum albumin and hemoglobin.

     

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