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中文摘要：
目的探讨联合检测白介素（IL）-6、超敏C反应蛋白（hs-CRP）和甲状旁腺素（PTH）对急性肾衰竭（ARF）与慢性肾衰竭（CRF）鉴别诊断的价值。方法 226例肾衰竭（RF）患者分为ARF组64例,CRF组162例,再随机选取其他非肾衰竭的肾病（NRF）组84例和健康对照组80例,检测并比较4组的IL-6、hs-CRP及PTH水平,用受试者工作特征曲线（ROC）找出各标志物的临床诊断界值,串联分析各组合（IL-6＋hs-CRP、IL-6＋PTH、hs-CRP＋PTH和IL-6＋hs-CRP＋PTH）的诊断效率,用矩阵决策法选择最适合鉴别诊断ARF和CRF的组合。结果 ARF组的IL-6和hs-CRP显著高于CRF与对照组（P〈0.01）,而PTH显著低于CRF组（P〈0.01）。CRF组的IL-6、hs-CRP和PTH与对照组比较差异有统计学意义（P〈0.01）。串联分析后IL-6＋hs-CRP组合可明显提高ARF的总符合率（TCR）及Youden指数（YI）,而灵敏度（SE）、特异度（SP）、阳性预测值（PPV）处于理想水平;PTH单项比联合检测更能保持CRF的SE、SP、PPV、TCR及YI处于理想水平。结论 IL-6、hs-CRP和PTH联合检查有助于ARF与CRF的鉴别诊断。
英文摘要：
Objective To explore the value of combined detection of interleukin（ IL）-6,high sensitive C-reactive protein（ hsCRP） and parathyroid hormone（ PTH） in differential diagnosis of acute renal failure（ ARF） and chronic renal failure（ CRF）. Methods226 cases of renal failure（ RF） patients were divided into ARF（ n = 64）,CRF groups（ n = 162）,randomly selected other non-renal failure nephrotic syndrome（ NRF）（ n = 84） and control groups（ n = 80）. IL-6,hs-CRP and PTH levels of all the subjects were detected. The diagnostic efficiency of each combination,IL-6＋hs-CRP,IL-6＋PTH,hs-CRP ＋PTH and IL-6＋hs-CRP ＋PTH were analyzed for choosing the most suitable combination of differential diagnosis of ARF and CRF by matrix method.Results The levels of IL-6 and hs-CRP in ARF group were significantly higher than those in CRF and control groups（ P〈0.01）,while the level of PTH was significantly lower than that of CRF group（ P〈0.01）,and there was no significant difference between NRF and control groups. The levels of IL-6,hs-CRP and PTH in CRF group had significant differences between NRF and control group（ P〈0.01）. The series IL-6＋hs-CRP combination significantly improved the total coincidence rate（ TCR） and Youden index（ YI）,SE,SP,PPV in the ideal level of ARF; while single of PTH maintained SE and SP more than combined detection,PPV,TCR and YI in the ideal level of CRF.Conclusions Combined detection of IL-6,hs-CRP and PTH is helpful for the differential diagnosis of ARF and CRF.
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