선별 소변검사의 단백과 비중을 결합한 검사지표의 평가
Evaluation of a Test Index Obtained by Coupling Protein with Specific Gravity of Screening Urine Test
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배경: 요단백량의 정량적 측정에는 24시간 요단백 측정이 표준검사이나, 검체채취가 어려워 그 과정에서 오류가 발생하기 쉽다. 본 연구에서는 간편하고 신속한 요 선별검사 결과를 결합하여 소변의 희석 및 농축을 반영한 결과를 얻고, 24시간 요단백량을 반영하는 지표로의 유용성을 평가하고자 하였다. 방법: 요시험지봉 단백과 정량단백, 그리고 요비중과 요삼투압 사이에서 도출된 회귀곡선식을 이용하여 ‘추정 요 단백/삼투압 비’를 구하였다. 병리학적 단백뇨, 신증후군 단백뇨 진단의 24시간 요단백량을 기준으로 ‘추정 요 단백/삼투압 비’와 널리 사용되고 있는 요 단백/크레아티닌 비의 민감도와 특이도를 각각 구하여 진단적 효용성을 서로 비교평가하였다. 결과: 요시험지봉 단백과 자연 로그를 취한 단회뇨 정량단백(r=0.86)과 요비중과 요삼투압 사이(r=0.74)에서 중등의 상관관계를 보였다. 추정 요 단백/삼투압 비와 정량 측정한 요 단백/크레아티닌 비 사이에서는 0.66의 상관계수가 확인되었다. ROC 분석 결과 추정 요 단백/삼투압 비 0.045에서 병리학적 단백뇨의 진단에 91.1%의 민감도와 88.6%의 특이도를 보였고 0.204에서 신증후군 단백뇨의 진단에 100%와 80.4%의 민감도와 특이도를 보였다결론: 기본검사인 요시험지봉 단백과 요비중의 결과를 결합함으로써 신질환의 선별진단 시 비용-효과 면에서 유용한 정보를 제공할 수 있을 것으로 생각된다.
Abstract
Background: The 24-hr urine protein excretion test is regarded as a standard for quantitative urinary protein analysis; however, collection of urine over 24 hr is troublesome and errors may occur during the process. We obtained a test index reflecting diluted or concentrated urine by coupling the results of a simple and rapid routine urine analysis and evaluated its usefulness as a marker that quantitatively reflects the 24-hr urine protein excretion. Methods: The estimated urine protein-osmolality ratio (Pro/Osm) was obtained by two linear regression equations between urine dipstick protein and natural logarithm of the protein concentration, and between urine specific gravity (SG) and urine osmolality (Osm). Sensitivity and specificity of ‘estimated urine Pro/Osm’ and the widely used urine protein-creatinine ratio were evaluated for their efficiency in diagnosing pathological proteinuria and nephrotic proteinuria based on 24-hr urine protein excretion. Results: Moderate correlations were noted between protein concentration determined by the urine dipstick protein assay and natural logarithm of protein concentration (r=0.86) and between urine SG and urine Osm (r=0.74). The receiver operating characteristics analysis showed that an estimated urine Pro/Osm value of 0.045 had a sensitivity of 91.1% and a specificity of 88.6% for diagnosing pathological proteinuria, and a value of 0.204 had a sensitivity of 100% and a specificity of 80.4% for diagnosing nephrotic proteinuria. Conclusions: Coupling the results of urine dipstick protein and urine SG determined by the routine analysis will provide additional useful information that will make the screening of renal diseases more cost-effective.
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