摘要
目的尿液中肾损伤标志物对急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）及非ARDS并发急性肾损伤（acutekidneyinjury，AKI）诊断与预后评估价值是否存在差异尚不清楚。文中旨在探讨尿液中肾损伤标志物在异质性人群中的诊断与预后评估差异。方法连续收集2009年1月1日至2015年12月31日南京医科大学附属无锡第二医院ICU住院304例患者的临床资料，含ARDS组105例，其中肺内ARDS亚组49例，肺外ARDS亚组48例；非ARDS组199例。利用ELISA法检测入ICU48h内尿中性粒细胞明胶酶相关脂质运载蛋白（urineneutrophil gelatinase-associated lipocalin，uNGAL），肝型脂肪酸结合蛋白（urineL—typefattyacid—bindingprotein，uL-FABP），肾损伤分子1（urinekidneyinjurymolecule-1，KIM-1），白细胞介素18（urineinterleukin-18，uIL-18）水平，对各组的临床资料及肾损伤标志物进行组间比较，采用ROC曲线分析比较各组及各组并发AKI者肾损伤标志物诊断价值的差异。利用Logistic回归分析评估尿液中肾损伤标志物对住院死亡的预后评估差异。结果与未并发AKI者比较，并发AKI者ARDS组uKIM．1水平明显升高[4．68（54．74，270．54）郴1．02（0．57，3．01），P=0．000]，非ARDS组uL—FABP水平亦明显升高[102．69（37．98，348．09）伽53．52（10．86，141．39），P=0．009]。ARDS组中，4项肾损伤标志物联合诊断AKI的AUC值为0．81（0．70～0．92），较uNGAL的0．57（0．43～0．70）、uL-FABP的0．55（0．39—0．71）、uIL-18的0．56（0．40—0．72）均明显增大（P〈0．05）。肺内ARDS亚组与肺外ARDS亚组4项联合诊断AKI的AUC较uNGAL、uL-FABP及uIL-18单项检测的AUC明显增大（P〈0．05）。uKIM-1预测死亡的OR值：ARDS组为1．529（95％CI：1．148—2．036）、肺内ARDS亚组为1．593（95％CI：1．070—2．369）、肺外ARDS亚组为1．512（95％CI：1．005—2．274）。结论尿液中�
Objective The purpose of study was to investigate the differences in the value of urine acute kidney injury （AKI） biomarkers in the diagnosis and prognosis of AKI in patients with or without acute respiratory distress syndrome （ARDS）. Methods We collected the clinical data about 304 ICU patients, in- cluding 105 ARDS （49 in the lungs and 48 outside the lungs） and 199 non-ARDS cases. Using ELISA, we determined the levels of uNGAL, uL-FABP, uKIM-1, and uIL-18 in the first 48 hours, compared the clinical data and AKI biomarkers between different groups of patients. We analyzed the differences in the diagnostic value of the AKI biomarkers using the ROC curve and their value in predicting hospital mortality by logistic regression analysis. Results Compared with the patients without AKI, the AKI cases exhibited a signif- icantly increased level of uKIM-1 （ 1.02 [ 0.57, 3.01 ] vs 4.68 [ 54.74, 270.54 ], P = 0. 000） in the ARDS group and that of uL- FABP in the non-ARDS group （102.69 [37.98, 348.09] vs 53.52 [10.86, 141.39], P =0.009）. In the ARDS group, the area under the ROC curve （AUC） for the combined efficiency of the four AKI biomarkers was 0.81 （95% CI 0.70 -0.92）, markedly higher than that of uNGAL （0.57 [95% CI 0.43 -0.70] ）, uL-FABP （0.55 [95% CI 0.39 -0.71 ] ）, and ulL-18 （0.56 [95% CI 0.40 - 0.72 ] ） alone （ P 〈 0. 05 ） , so was the AUC for the combined efficiency of the four biomarkers than that of each biomarker alone in the patients with ARDS in or outside the lungs （ P 〈 0. 05 ）. The OR value of uKIM-1 for predicting hospital mortality was 1. 529 （95% CI 1. 148 -2. 036） in the ARDS group, 1. 593 （95% CI 1. 070 -2. 369） in the patients with ARDS in the lungs, and 1. 512 （95% CI 1. 005 -2. 274） in those with ARDS outside the lungs. Conclusion There were differences of diagnostic and predictive value of Urine AKI biomarkers have different values in the diagnosis and prognosis of AKI in ARDS and non-ARDS patients and in those with ARDS in or outs
出处
《医学研究生学报》
CAS
北大核心
2016年第8期827-831,共5页
Journal of Medical Postgraduates
基金
南京医科大学科技发展基金项目(2013NJMU191)
