摘要
目的:探讨尿肾损伤分子-1(KIM-1)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)及肝型脂肪酸结合蛋白(L-FABP)对老年重症患者急性肾损伤(AKI)的早期诊断价值。方法:选取2016-01—2018-06期间本院收治的老年重症患者218例,依据其是否发生AKI分为AKI组(76例)和非AKI组(142例)。采用酶联免疫吸附法(ELISA)测定患者0、6、12、24h尿KIM-1、NGAL及L-FABP水平,酶法测定血尿素氮(BUN)、血肌酐(Scr)及胱抑素C(CyS C)水平。应用受试者工作特征(ROC)曲线评价不同时间点各指标对AKI的早期诊断价值。结果:在12、24h时间点,AKI组血清BUN、Scr及CyS C水平均明显高于非AKI组(P<0.05)。在6、12、24h时间点,AKI组尿KIM-1[(42.30±8.72)vs(19.63±6.14),(50.73±11.43)vs(22.84±7.05),(48.60±10.75)vs(25.15±7.42),pg/ml)、NGAL[(683.50±527.34)vs(447.38±325.24),(825.36±681.50)vs(465.82±360.13),(910.83±814.26)vs(494.70±423.65),ng/ml)]及L-FABP[(214.53±50.42)vs(24.71±10.93),(352.40±62.73)vs(26.28±11.40),(190.75±48.22)vs(27.10±11.54),μg/(g·Cr)]水平均明显高于非AKI组(P<0.05)。血清BUN、Scr及CyS C单项诊断AKI的敏感性和特异性均较差,三者联合诊断AKI的敏感性和特异性为79.5%和77.2%。尿12hKIM-1、NGAL及L-FABP水平诊断AKI的AUC(95%CI)分别为0.883(0.826～0.944)、0.918(0.857～0.973)、0.906(0.848～0.962),其最佳截值分别为41.25pg/ml、670.18ng/ml、196.30μg/(g·Cr)。尿12hKIM-1+NGAL+L-FABP三者联合诊断AKI的敏感性和特异性最高,为97.2%和88.3%。结论:尿KIM-1、NGAL及L-FABP在老年重症患者AKI早期即明显升高,三者联合检测有助于提高AKI早期诊断的准确性。
Objective:To investigate the early diagnostic value of urine kidney injury molecular-1(KIM-1),neutrophil gelatinase associated lipid transporter(NGAL)and hepatic fatty acid binding protein(L-FABP)in elderly patients with severe acute kidney injury(AKI).Method:Two hundred and eighteen cases of severe elderly patients treated in our hospital from January 2016 to June 2018 were included.They were divided into AKI group(76 cases)and non AKI group(142 cases)according to whether they had AKI.Enzyme linked immunosorbent assay(ELISA)were used to determine the levels of urine KIM-1,NGAL and L-FABP and enzyme method were used to determine the levels of blood urea nitrogen(BUN),serum creatinine(Scr)and cystatin C(CyS C)at the 0 hour,the 6 th hour,the 12 nd hour,and the 24 th hour.The ROC curve was used to evaluate the early diagnostic value of various indexes at different time points to AKI.Result:The levels of serum BUN,Scr and CyS C in the AKI group were significantly higher than those in the non AKI group at the 12 nd hour and the 24 th hour(P<0.05).The levels of KIM-1[(42.30±8.72)vs(19.63±6.14),(50.73±11.43)vs(22.84±7.05),(48.60±10.75)vs(25.15±7.42),pg/ml)],NGAL[(683.50±527.34)vs(447.38±325.24),(825.36±681.50)vs(465.82±360.13),(910.83±814.26)vs(494.70±423.65)ng/ml]and L-FABP[(214.53±50.42)vs(24.71±10.93),(352.40±62.73)vs(26.28±11.40),(190.75±48.22)vs(27.10±11.54),μg/(g·Cr)]in group AKI were significantly higher than those in the non AKI group at the 6 th hour,the 12 nd hour,and the 24 th hour(P<0.05).The sensitivity and specificity of serum BUN,Scr and CyS C in the single diagnosis of AKI were poor,and the sensitivity and specificity of the three indexes combined diagnosis of AKI were 79.5% and 77.2%.The levels of urinary 12 hKIM-1,NGAL and L-FABP level diagnosis AKI of AUC(95%CI)were 0.883(0.826-0.944),0.918(0.857-0.973),0.906(0.848-0.962),respectively,and the best cut-off values were 41.25 pg/ml、670.18 ng/ml、196.30μg/(g·Cr).The sensitivity and specificity of 12 hKIM-1+NGAL+L-FABP combined dia
作者
钟开义
黎宝仁
张祖文
蓝燕
苏佩琼
陈雪丽
ZHONG Kaiyi;LI Baoren;ZHANG Zuwen;LAN Yan;SU Peiqiong;CHEN Xueli(Department of Nephrology,Central Hospital of Western Hainan,Danzhou,Hainan,571799,China)
出处
《临床急诊杂志》
CAS
2018年第12期850-854,858,共6页
Journal of Clinical Emergency
基金
海南省医学科研基金资助(No:16A500082)
