摘要
目的:探讨尿液肾损伤分子-1(uKIM-1)和尿液肝型脂肪酸结合蛋白(uL-FABP)用于脓毒症患者急性肾损伤(AKI)的临床诊断价值。方法:纳入2016年2月至2018年2月就诊的脓毒症患者165例,根据入住ICU后24 h内是否发生AKI分为AKI组(n=81)及无AKI组(n=84)。使用酶联免疫分析(ELISA)方法检测患者uKIM-1及uL-FABP水平,ROC曲线分析这两个指标用于诊断AKI的临床价值。结果:AKI组uKIM-1水平[(6.16±2.71)vs.(3.37±1.29)ng·mg-1,P<0.001]及u L-FABP水平[(465.11±193.54)vs.(255.51±87.99)ng·mg-1,P<0.001]高于无AKI组。不同AKI分期患者中,AKI-3期u KIM-1和u LFABP水平[(8.06±2.62 ng·mg-1)、(602.42±196.74)ng·mg-1]高于AKI-2期[(6.30±2.26)ng·mg-1、(449.27±148.77)ng·mg-1]及AKI-1期[(4.67±2.22)ng·mg-1、(379.29±171.89)ng·mg-1]。AKI组中,u KIM-1与血肝酐(s Cr)(r=0.42,P<0.05)、乳酸(r=0.55,P<0.05)、序贯器官衰竭评估(SOFA)评分(rs=0.25,P<0.05)、AKI分期(rs=0.46,P<0.05)呈正相关,与肾小球滤过率估计值(eGFR)(r=-0.31,P<0.05)呈负相关;uL-FABP与s Cr(r=0.34,P<0.05)、乳酸(r=0.68,P<0.05)、SOFA评分(rs=0.30,P<0.05)、AKI分期(rs=0.51,P<0.05)呈正相关,与e GFR(r=-0.23,P<0.05)呈负相关。在用于区别诊断AKI及非AKI患者时,uKIM-1、L-FABP及两者联合的AUC分别为0.83、0.81及0.88;在用于区别诊断AKI-3期与AKI-1/2期患者时,uKIM-1、u-FABP及两者联合的AUC分别为0.77、0.78及0.82。结论:脓毒症患者并发AKI时uKIM-1和uL-FABP升高,且两项指标用于诊断AKI分期具有较高的价值。
Objective:To investigate the diagnostic value of urinary kidney injury moleculer-1(uKIM-1)and urinary liver fatty acid binding protein(uL-FABP)in spesis patients with acute kidney injury(AKI).Methods:A total of 165 spesis patients from February 2016 to February 2018 were involved,and they were divided into AKI group(n=81)and non-AKI group(n=84)according to whether AKI occured within 24 hours after ICU accepted.The u KIM-1 and uL-FABP levels were tested with enzyme-linked immunosorbent assay(ELISA).The correlations between uL-FABP(or uKIM-1)and clinical parameters were analyzed,and diagnostic values of u KIM-1 and u L-FABP for AKI were calculated by receiver operating characteristic curve(ROC).Results:The u KIM-1[(6.16±2.71)vs.(3.37±1.29)ng·mg-1,P<0.001]and uL-FABP[(465.11±193.54)vs.(255.51±87.99)ng·mg-1,P<0.001]levels in AKI group were both higher than those in non-AKI group.In different AKI stage,uKIM-1 and u L-FABP levels in patients of AKI-3 stage[(8.06±2.62)ng·mg-1,(602.42±196.74)ng·mg-1]were higher than those of AKI-2[(6.30±2.26)ng·mg-1,(449.27±148.77)ng·mg-1]and AKI-1[(4.67±2.22)ng·mg-1,(379.29±171.89)ng·mg-1]stage.In AKI group,the u KIM-1 level was positively correlated with s Cr(r=0.42,P<0.05),lactic acid(r=0.55,P<0.05),SOFA score(rs=0.25,P<0.05)and AKI stage(rs=0.46,P<0.05),and negatively correlated with eGFR(r=-0.31,P<0.05);the uL-FABP level was positively correlated with s Cr(r=0.34,P<0.05),lactic acid(r=0.68,P<0.05),SOFA score(r=0.30,P<0.05)and AKI stage(rs=0.51,P<0.05),and negatively correlated with e GFR(r=-0.23,P<0.05).Area under curve(AUC)of u KIM-1 and uL-FABP used for the diagnosis of AKI in spesis patients was0.83 and 0.81,and AUC of uKIM-1 combined with u L-FABP was 0.88.AUC of u KIM-1 and uL-FABP used to distinguish AKI-3 from AKI-1/2 was 0.77 and 0.78,and AUC of u KIM-1 combined with uL-FABP was 0.82.Conclusion:The uKIM-1 and uL-FABP levels are evaluated in sepsis patients with AKI,and the two parameters can be used for AKI stage diagnosis.
作者
向礼芳
宋玉燕
邓建琼
XIANG Lifang;SONG Yuyan;DENG Jianqiong(Department of Emergency,Chongqing Public Health Medical Institution,Chongqing 400000,China;Department of Critical Medicine,Chongqing Public Health Medical Institution,Chongqing 400000,China;Department of Respiratory,Chongqing Public Health Medical Institution,Chongqing 400000,China)
出处
《现代医学》
2020年第7期845-850,共6页
Modern Medical Journal
作者简介
向礼芳(1987-),女,重庆人,主治医师。E-mail:xianglifangliang@163.com;通信作者:邓建琼E-mail:d547121366@163.com
