文章：

系统性AL型淀粉样变性患者真实世界队列中尿ACR与24小时蛋白尿的相关性

Correlation between urine ACR and 24-h proteinuria in a real-world cohort of systemic AL amyloidosis patients

原文发布日期：2020-12-11

DOI: 10.1038/s41408-020-00391-2

类型: Article

开放获取: 是

英文摘要：

A 24-h urine protein collection (24hUP), the gold standard for measuring albuminuria in systemic AL amyloidosis, is cumbersome and inaccurate. We retrospectively reviewed 575 patients with systemic AL amyloidosis to assess the correlation between a urine albumin to creatinine ratio (uACR) and the 24hUP. The uACR correlated strongly with 24hUP at diagnosis (Pearson’s r = 0.87, 95% CI 0.83–0.90) and during the disease course (Pearson’s r = 0.88, 95% CI 0.86–0.90). A uACR ≥300 mg/g estimated a 24hUP ≥ 500 mg with a sensitivity of 92% and specificity of 97% (area under the receiver operating curve = 0.938, 95% CI 0.919–0.957). A uACR cutoff of 3600 mg/g best predicted a 24hUP > 5000 g (sensitivity 93%, specificity 94%), and renal stage at diagnosis was strongly concordant using either 24hUP or uACR as the proteinuria measure (k = 0.823, 95% CI 0.728–0.919). In patients with serial urine collections, a > 30% decrease in uACR predicted a > 30% decrease in 24hUP with a sensitivity of 94%. In conclusion, the uACR is a reliable and convenient method for ruling out proteinuria >500 mg per day, prognosticating renal outcomes, and assessing renal response to therapy. Further studies are needed to validate the uACR cutoffs proposed in this study.
 

摘要翻译： 

24小时尿蛋白定量作为评估系统性AL淀粉样变性患者蛋白尿的金标准，操作繁琐且结果欠精确。我们回顾性分析了575例系统性AL淀粉样变性患者，评估尿白蛋白肌酐比值与24小时尿蛋白定量的相关性。结果显示，无论是初诊时还是病程中，uACR与24hUP均呈现强相关性。uACR≥300mg/g可判定24hUP≥500mg/天，其敏感度为92%，特异度为97%。uACR临界值3600mg/g能最佳预测24hUP>5000mg/天，诊断敏感度为93%，特异度为94%。采用uACR或24hUP作为蛋白尿评估指标时，初诊肾脏分期具有高度一致性。在系列尿标本检测中，uACR下降>30%可预测24hUP下降>30%，敏感度达94%。结论表明，uACR是排除每日蛋白尿>500mg、预测肾脏预后及评估治疗反应的可靠便捷方法。本研究提出的uACR临界值尚需进一步验证。

原文链接：

Correlation between urine ACR and 24-h proteinuria in a real-world cohort of systemic AL amyloidosis patients