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中华实验和临床感染病杂志(电子版)

中华实验和临床感染病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (06) : 461 -466. doi: 10.3877/cma.j.issn.1674-1358.2020.06.004

所属专题： 文献；

论著

血清胱抑素C和尿微量白蛋白联合检测在人类免疫缺陷病毒感染者肾功能损伤检测中的应用价值
赵娜新1, 曾志立1, 郜桂菊2,†(), 梁洪远2, 肖江2, 杨涤2, 王芳2, 陈美玲3, 孙继云4   
  1. 1. 100015　北京，首都医科大学附属北京地坛医院，首都医科大学艾滋病临床与诊疗研究中心，北京市中西医结合感染性疾病研究所肾内科
    2. 100015　北京，首都医科大学附属北京地坛医院感染一科
    3. 100015　北京，首都医科大学附属北京地坛医院病案统计室
    4. 100015　北京，首都医科大学附属北京地坛医院检验科
  • 收稿日期:2020-04-15 出版日期:2020-12-25
  • 通信作者: 郜桂菊
  • 基金资助:
    "十三五"重大专项课题(No. 2017ZX10202101004); 北京市科委首都特色课题(No. Z171100001017053); 首都医科大学附属北京地坛医院青年人才发展基金"萌芽"支持计划项目(No. DTMY201808)

Value of combined detection of serum cystatin C and urinary microalbumin on detection of human immunodeficiency virus-infected patients with renal dysfunction

Naxin Zhao1, Zhili Zeng1, Guiju Gao2,†(), Hongyuan Liang2, Jiang Xiao2, Di Yang2, Fang Wang2, Meiling Chen3, Jiyun Sun4   

  1. 1. Department of Nephrology, Beijing Ditan Hospital, Capital Medical University, Clinical and Research Center of Infectious Diseases, Institute of Infectious Diseases with Integrated Traditional Chinese and Western Medicine, Beijing 100015, China
    2. Division 1st, Department of Infection Diseases, Beijing Ditan Hospital, Capital Medical University, Clinical and Research Center of Infectious Diseases, Institute of Infectious Diseases with Integrated Traditional Chinese and Western Medicine, Beijing 100015, China
    3. Department of Medical Records Statistic, Beijing Ditan Hospital, Capital Medical University, Clinical and Research Center of Infectious Diseases, Institute of Infectious Diseases with Integrated Traditional Chinese and Western Medicine, Beijing 100015, China
    4. Department of Clinical Laboratory, Beijing Ditan Hospital, Capital Medical University, Clinical and Research Center of Infectious Diseases, Institute of Infectious Diseases with Integrated Traditional Chinese and Western Medicine, Beijing 100015, China
  • Received:2020-04-15 Published:2020-12-25
  • Corresponding author: Guiju Gao
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引用本文：

赵娜新, 曾志立, 郜桂菊, 梁洪远, 肖江, 杨涤, 王芳, 陈美玲, 孙继云. 血清胱抑素C和尿微量白蛋白联合检测在人类免疫缺陷病毒感染者肾功能损伤检测中的应用价值[J]. 中华实验和临床感染病杂志(电子版), 2020, 14(06): 461-466.

Naxin Zhao, Zhili Zeng, Guiju Gao, Hongyuan Liang, Jiang Xiao, Di Yang, Fang Wang, Meiling Chen, Jiyun Sun. Value of combined detection of serum cystatin C and urinary microalbumin on detection of human immunodeficiency virus-infected patients with renal dysfunction[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2020, 14(06): 461-466.

目的

评估血肌酐和尿常规的常规检测基础上联合血清胱抑素C和尿微量白蛋白检测在人类免疫缺陷病毒（HIV）感染者肾功能损伤检测中的应用价值。

方法

以2019年2～5月于首都医科大学附属北京地坛医院感染一科住院的169例HIV感染者为研究对象，完善其尿常规、尿微量白蛋白、血肌酐、血清胱抑素C检测；分析尿蛋白及尿微量白蛋白的阳性检出率及其差异，血肌酐升高及血清胱抑素C升高的比例及其差异。计算应用替诺福韦酯（TDF）及合并丙型肝炎、高血压、糖尿病、肿瘤的肾功能损伤的相对危险度。

结果

169例HIV感染者中尿常规示尿蛋白阳性者5例（3.0%），尿微量白蛋白升高者17例（10.1%），两者阳性检出率差异具有统计学意义（χ2 = 5.9、P = 0.007）。血肌酐升高者10例（5.9%），血清胱抑素C升高者20例（11.8%），两者阳性检出率差异具有统计学意义（χ2 = 3.0、P = 0.042）。在尿常规和血肌酐检测的基础上联合检测尿微量白蛋白和血清胱抑素C的总体阳性检出率为49例（30.0%）。CD4+ T淋巴细胞计数< 200个/μl与≥ 200个/μl组患者血清胱抑素C水平分别为0.94（0.83，1.05）mg/L、0.85（0.77，0.95）mg/L，差异具有统计学意义（Z =-3.02、P = 0.003）。应用TDF及合并丙型肝炎、高血压、糖尿病、肿瘤的肾功能损伤的相对危险度分别为1.1、1.5、1.9、2.2和1.4。

结论

HIV感染者中，单纯以尿常规为依据评估有无蛋白尿，以血肌酐水平为依据评估肾小球滤过功能会低估肾功能损伤的患病率。在常规检测血肌酐和尿常规的基础上联合检测血清胱抑素C和尿微量白蛋白在提高HIV感染者肾功能损伤检出率方面具有重要的应用价值。低CD4+ T淋巴细胞计数、应用TDF及合并丙型肝炎、高血压、糖尿病、肿瘤均为肾功能损伤的危险因素。

关键词: 获得性缺陷免疫综合征, 肾功能损伤, 胱抑素C
Objective

To investigate the value of combined detection of serum cystatin C and urinary microalbumin on the basis of serum creatinine and routine urine detection in detection of renal dysfunction of patients with human immunodeficiency virus infection.

Methods

Total of 169 patients with HIV infection were collected in Division 1st, Department of Infection Diseases, Beijing Ditan Hospital, Capital Medical University from February to May 2019. The levels of urine routine, urine microalbumin, serum creatinine and serum cystatin C of the patients were detected, respectively. The positive rates of urine protein and urine microalbumin and their difference, the proportion of serum creatinine elevated and serum cystatin C elevated and their difference were analyzed. The relative risks of renal function injury with tenofovir disoprox (TDF) application and complicated with hepatitis C, hypertension, diabetes and tumor were calculated, respectively.

Results

Among the 169 cases with HIV infection, 5 cases (3.0%) were with proteinuria and 17 cases (10.1%) with microalbuminuria, with significant difference (χ2 = 5.9, P = 0.007). There were 10 cases (5.9%) with serum creatinine elevated and 20 cases (11.8%) with serum cystatin C increased, with significant difference (χ2 = 3.0, P = 0.042). Serum creatinine increased in 10 cases (5.9%), while cystatin C increased in 20 cases (11.8%). Combined detection of urinary microalbumin and serum cystatin C base on urine routine and serum creatinine detection, the overall positive rate was 30.0% (49 cases). The median serum cystatin C were 0.94 (0.83, 1.05) mg/L and 0.85 (0.77, 0.95) mg/L of patients with CD4+ T < 200 cells/UL and patients with ≥ 200 cells/UL, respectively, with significant difference (Z =-3.02, P = 0.003). The relative risks of TDF application and complicated with hepatitis C, hypertension, diabetes and tumor were 1.1, 1.5, 1.9, 2.2 and 1.4, respectively.

Conclusions

Among HIV-infected patients, the incidence of renal dysfunction would be underestimated if only based on urine routine for proteinuria and serum creatinine for glomerular filtration rate. The combined detection of serum cystatin C and urinary microalbumin besides urine routine and serum creatinine was important in the detection of renal dysfunction in patients with HIV infection. Lower CD4+ T lymphocyte count, use of TDF and complicated with hepatitis C, hypertension, diabetes and tumor were risk factors for renal dysfunction.

Key words: Acquired immune deficiency syndrome, Renal dysfunction, Cystatin C
表1 169例不同抗病毒治疗方案HIV感染者的血清胱抑素C和尿微量白蛋白水平
治疗方案 例（%） 血清胱抑素C [M（P25，P75），mg/L） 尿微量白蛋白[M（P25，P75），mg/L）
尚未开始抗病毒治疗 57（33.7） 0.89（0.80，1.00） 0.70（0.41，1.39）
3TC+ TDF+ EFV 66（39.1） 0.89（0.80，1.04） 0.70（0.30，1.37）
3TC+ TDF+ LPV/r 19（11.2） 0.92（0.85，1.02） 0.94（0.45，1.32）
3TC+ TDF+ DTG 5（3.0） 0.80（0.74，0.99） 0.53（0.35，1.08）
TAF/FTC/EVG/c 5（3.0） 1.90（0.86，2.17） 1.18（0.51，2.80）
3TC+ AZT + NVP 3（1.8） 0.68、0.73、0.86a 0.24、0.28、0.86a
3TC+ AZT + LPV/r 3（1.8） 0.69、0.88、0.89a 0.20、0.73、0.87a
3TC+ TDF + NVP 2（1.2） 0.76、0.80a 0.70、0.95a
不规范抗病毒治疗 3（1.8） 0.74、0.96、2.21a 0.20、0.54、3.36a
其他 6（3.6） 1.04（0.77，1.24） 0.74（0.22，2.71）
表2 169例不同CD4+ T淋巴细胞计数组HIV感染者血清胱抑素C和尿微量白蛋白水平
组别 例数 血清胱抑素C（mg/L） 尿微量白蛋白（mg/dl）
CD4+T< 200个/µl组 98 0.94（0.83，1.05） 0.71（0.38，1.37）
CD4+T≥ 200个/µl组 71 0.85（0.77，0.95） 0.70（0.27，1.19）
Z值   -3.02 -0.61
P值   0.003 0.54
表3 169例HIV感染者各项指标的阳性检出率
检测指标 异常例数（%）
尿常规 25（14.8）
尿潜血 24（14.2）
尿蛋白 5（3.0）
尿微量白蛋白升高 17（10.1）
血肌酐 10（5.9）
eGFR< 60 ml/min·1.73m2 4（2.4）
胱抑素C 20（11.8）
联合检测a 49（30.0）
表4 49例发生肾功能损伤HIV感染者的危险因素
相关因素 肾功能损伤的患病率（%） 相对危险度（RR）
TDF治疗   1.1
  是 30（30.0）  
  否 19（27.1）  
乙型肝炎   0.9
  是 3（27.3）  
  否 46（29.1）  
丙型肝炎   1.5
  是 3（42.9）  
  否 46（28.4）  
梅毒   0.9
  是 15（27.8）  
  否 34（29.6）  
高血压   1.9
  是 8（50.0）  
  否 41（26.8）  
糖尿病   2.2
  是 7（58.3）  
  否 42（26.8）  
肿瘤   1.4
  是 5（38.5）  
  否 44（28.2）  
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