【摘要】目的：探究血液透析患者C反应蛋白、白蛋白、铁蛋白联合检测对营养不良-炎症综合征的评估价值。方法：回顾性选取2025年2月至2026年2月我院收治的血液透析患者104例作为研究对象，根据是否发生营养不良-炎症综合征（MICS）分为MICS组51例和单纯透析组53例，获取患者临床资料，并于透析前检测血清C反应蛋白、白蛋白、铁蛋白水平，采用多因素logistic回归分析影响血液透析患者发生MICS的危险因素，并采用ROC曲线评估各指标联合检测对MICS的诊断价值。结果：MICS组血清C反应蛋白、铁蛋白水平高于单纯透析组，血清白蛋白水平低于单纯透析组（P<0.05）。logistic回归分析结果显示，C反应蛋白、白蛋白、铁蛋白水平是影响血液透析患者发生MICS的危险因素（P<0.05）。ROC曲线分析结果显示，当白蛋白的最佳诊断截断值为（33.89）g/L，C反应蛋白的最佳诊断截断值为（13.17）mg/L，铁蛋白的最佳诊断截断值为（247.53）ng/mL，此时联合检测诊断MICS的AUC为0.973、敏感度为（98.00）和特异度为（83.02），高于任一单项指标检测（P<0.05）。结论：血液透析患者血清C反应蛋白、铁蛋白升高，血清白蛋白水平下降，三者联合诊断MIAS的临床价值较高。

目的 探讨血清胱抑素C（SCys-C）、同型半胱氨酸（Hcy）及尿微量白蛋白（UmAlb）在高血压患者肾损害早期评估中的应用价值。方法 选择2022年9月—2023年9月期间福建中医药大学附属第三人民医院接收的150例高血压患者作为观察组,另选择健康体检者150例为对照组,测定肾小球滤过率（GFR）、SCys-C、Hcy、UmAlb,比较不同血压程度及对照组的各指标水平,比较观察组各指标检测阳性率及诊断符合率,依据GFR值评估肾损害程度,比较不同肾损害程度患者的SCys-C、Hcy、UmAlb水平。结果 高血压2级、高血压3级患者SCys-C、Hcy、UmAlb水平高于高血压1级患者（t=5.255、10.976、21.578,P<0.05;t=7.378、18.012、23.708,P<0.05）及对照组患者（t=8.308、19.675、31.891,P<0.05;t=10.661、31.511、21.578,P<0.05）,高血压3级患者高于高血压2级患者（t=2.776、12.725、7.779,P<0.05）。观察组肾损害患者SCys-C、Hcy、UmAlb的阳性率79.41%、73.53%、83.82%高于无肾损害患者的阳性率6.10%、4.88%、6.10%（χ²=83.733、76.040、92.613,P<0.05）。观察组中重度肾损害、轻度肾损害患者的SCys-C、Hcy、UmAlb水平高于无损害患者（t=7.567、24.214、30.836,P<0.05;t=5.783、16.054、25.164,P<0.05）,中重度肾损害高于轻度肾损害患者（t=2.685、7.179、9.561,P<0.05）。结论 高血压分级越高患者的SCys-C、Hcy、UmAlb水平越高,各指标联合检测的阳性率高,而且SCys-C、Hcy、UmAlb水平越高,肾损害程度越严重。

Objective To explore the application value of serum cystatin C（SCys-C）,homocysteine（Hcy） and urinary microalbumin（UmAlb）in early assessment of renal damage in hypertensive patients．Methods A total of 150 hypertensive patients admitted to the Third People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine from September 2022 to September 2023 were selected as the observation group,and 150 healthy individuals were selected as the control group．Glomerular filtration rate（GFR）,serum cystatin C（SCys-C）,homocysteine（Hcy）,and UmAlb were measured,and the levels of various indicators in different blood pressure levels and the control group were compared．The positive rate and diagnostic accuracy of each indicator in the observation group were compared,and the degree of renal damage was evaluated based on GFR values．The levels of SCys-C,Hcy and UmAlb in patients with different degrees of renal damage were compared．Results The levels of SCys-C,Hcy and UmAlb in patients with grade 2 and grade 3 hypertension were significantly higher than those in patients with grade 1 hypertension（t=5.255,10.976,21.578,P<0.05;t=7.378,18.012,23.708,P<0.05）,as well as in the control group（t=8.308,19.675,31.891,P<0.05;t=10.661,31.511,21.578,P<0.05）,patients with grade 3 hypertension were significantly higher than those with grade 2 hypertension（t=2.776,12.725,7.779,P<0.05）．The positive rates of SCys-C,Hcy and UmAlb in patients with renal injury in the observation group were 79.41%,73.53% and 83.82%,which were significantly higher than the positive rates of 6.10%,4.88% and 6.10% in patients without renal injury（χ²=83.733,76.040,92.613,P<0.05）．The levels of SCys-C,Hcy and UmAlb in patients with severe and mild kidney damage in the observation group were significantly higher than those in patients without damage（t=7.567,24.214,30.836,P<0.05;t=5.783,16.054,25.164,P<0.05）,patients with moderate to severe kidney damage were significantly higher than those with mild kidney damage（t=2.685,7.179,9.561,P<0.05）．Conclusions The higher the grading of hypertension,the higher the levels of SCys-C,Hcy and UmAlb in patients,and the higher the positive rate of combined detection of various indicators．Moreover,the higher the levels of SCys-C,Hcy and UmAlb,the more severe the renal damage．

目的 研究添加与不加甲苯对24 h尿微量总蛋白(MPr)和尿微量白蛋白(UMA)定量测定的影响。方法 收集各个浓度段门诊及住院病人的新鲜随机尿共82份,检测即刻与在低、中、高温度条件下,加和不加甲苯保存24 h后尿液MPr和UMA的浓度,通过配对t检验方法检验差异有无统计学意义。结果 即刻尿MPr的值与低中温条件下、有无甲苯的24 h尿MPr的检测值比较,差异均无统计学意义(P＞0.05),但与在高温条件有无甲苯检测值比较,差异均有统计学意义(P＜0.05);即刻尿UMA的值与低中温条件下、有无甲苯的24 h尿UMA检测值比较,差异均无统计学意义(P＞0.05),与高温条件下有无甲苯检测值相比,差异均有统计学意义(P＜0.05);同一温度保存24 h,得到尿MPr、尿UMA的检测值,有无甲苯的检测结果比较,差异均无统计学意义(P＞0.05)。结论 实验证明甲苯在24h尿MPr与尿UMA的定量检测中无使用的必要性。

Objective To investigate the effect of toluene in the quantitative detection of 24 hour(24 h) urine micro protein(MPr) and urine micro albumin(UMA). Methods Eighty-two random urine of the patients with different concentrations were collected.The group without toluene and the other group with toluene were stored at the low, medium and high tempreture for 24 h respectively. Then MPr and UMA were measured in 0 h and 24 h. Paired t-test was used to test whether the difference was statisticallysignificant. Results When stored at the low and medium temperature,the results of immediate detection of MPr and UMA were compared with those of the addition of toluene or without for 24 h. The difference was not statistically significant (P>0.05). However, there was significant difference in MPr and UMA value of urine at high temperature under the same comparison(P<0.05). Stored at the same temperature for 24 hours, the results of MPr and UMA were compared between the adding groups and the non-adding groups. The results showed that there was no significant difference between them. Conclusion The specimens for the quantitative detection of the 24 h MPr and UMA are not need to be added with toluene, and toluene in the urine is not preservatively effective.