随机尿钾与尿肌酐比值在判断肾性失钾中的应用价值研究

孙易红; 赵炼玲; 王晓书; 任艳; 田浩明; 陈涛

doi:10.12182/20230560201

随机尿钾与尿肌酐比值在判断肾性失钾中的应用价值研究

Application Value of Random Urine Potassium-to-Creatinine Ratio in Diagnosing Renal Potassium Loss

摘要

摘要:
目的分析随机尿钾/尿肌酐（rUK/Ucr）在判断肾性失钾中的应用价值。

方法纳入2017–2021年诊断为低钾血症患者〔包括肾性失钾（373例）、非肾性失钾（83例）〕、血钾正常（358例）的住院患者。收集临床资料，分析rUK/Ucr与24 h尿钾（24 hUK）的相关性；针对低钾血症患者绘制受试者工作特征（ROC）曲线，分析rUK/Ucr判断肾性失钾的价值。

结果血钾在血钾正常组、肾性失钾组、非肾性失钾组依次降低（P<0.01）。肾性失钾组24 hUK、rUK/Ucr大于非肾性失钾及血钾正常组（P<0.01）。rUK/Ucr与24 hUK呈低到中度相关。24 hUK、rUK/Ucr判断肾性失钾的曲线下面积（AUC）分别为0.73、0.71，rUK/Ucr判断肾性失钾的最佳切点为3.4时，灵敏度为67.59%，特异度为67.53%。

结论 rUK/Ucr与24 hUK的相关性一般，rUK/Ucr预测肾性失钾的价值与24 hUK相当。在无法获取24 h尿液标本时，可推荐使用rUK/Ucr替代24 hUK来初步判断是否存在肾性失钾，其最佳诊断切点为3.4。

Abstract:
Objective To analyze the value of applying random urine potassium-to-creatinine ratio (rUK/Ucr) in diagnosing renal potassium loss.

Methods patients diagnosed with hypokalemia, including 373 cases of renal potassium loss, 83 cases of non-renal potassium loss , and 358 cases of normal serum potassium, between 2017 and 2021 were enrolled. The clinical data of the patients were collected and the correlation between rUK/Ucr and 24-hour urine potassium (24 hUK) in the three groups was analyzed. The receiver operating characteristic (ROC) curve was used to analyze the value of applying rUK/Ucr in diagnosing renal potassium loss.

Results Serum potassium decreased in the normal serum potassium group, the renal potassium loss group, and the non-renal renal potassium loss group (P<0.01). The 24 hUK and the rUK/Ucr of the renal potassium loss group were higher than those of the non-renal potassium loss group and normal serum potassium group (P<0.01). rUK/Ucr showed low to moderate correlation with 24 hUK. The AUC of 24 hUK and rUK/Ucr for determining renal potassium loss were 0.73 and 0.71, respectively. When the optimal cutoff point of rUK/Ucr for determining renal potassium loss was 3.4, the sensitivity was 67.6% and the specificity was 67.5%.

Conclusion rUK/Ucr shows a moderate correlation with 24 hUK and its accuracy in determining renal potassium loss is comparable to that of 24 hUK. When 24-hour urine samples cannot be obtained, it is recommended that rUK/Ucr be used instead of 24 hUK to determine whether renal potassium loss exists, with the optimal cutoff point for diagnosis being 3.4.

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