摘要
目的探讨尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子-1(KIM-1)联合急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分预测脓毒症急性肾损伤(AKI)患者预后的价值。方法选取海南西部中心医院收治的脓毒症并发AKI患者108例,根据其是否死亡分为存活组(n=72)和死亡组(n=36)。采用酶联免疫吸附法测定各组尿NGAL、KIM-1水平,并记录其APACHEⅡ评分。应用受试者工作特征(ROC)曲线评价尿NGAL、KIM-1及APACHEⅡ评分对脓毒症并发AKI患者预后的价值。结果死亡组尿NGAL(970.2±705.2ng/mLvs612.5±415.4ng/mL)、KIM-1[(62.6±12.4)ng/Lvs(28.8±7.2)ng/L]及APACHEⅡ评分[(26.8±8.3)分vs(17.90±6.20)分]均明显高于存活组(P<0.05)。ROC曲线分析显示,尿NGAL、KIM-1及APACHEⅡ评分预测AKI患者死亡的最佳截取值分别为805.26ng/mL、50.35ng/L、23.90分,三者联合预测脓毒症并发AKI患者死亡的曲线下面积(0.937,95%CI0.885~0.987)、敏感度(96.3%)和特异度(88.0%)较高。结论尿NGAL、KIM-1及APACHEⅡ评分三者联合检测在评估脓毒症并发AKI患者死亡时具有良好的预测价值,可提高脓毒症并发AKI患者预后评估的准确性。
Objective To investigate the prognostic value of urinary neutrophil gelatinase-associated lipid carrier protein (NGAL),kidney injury molecule-1 (KIM-1) combined with acute physiology and chronic health Ⅱ(APACHE Ⅱ)scoring in patients with sepsis-induced acute kidney injury (AKI).Methods A total of 108 patients with sepsis complicated with AKI admitted to Hainan Western Central Hospital were divided into the survival group ( n =72) and death group ( n =36) according to whether they died or not.Urinary NGAL and KIM-1 levels were measured with enzyme-linked immunosorbent assay (ELISA) and APACHE Ⅱ scores were recorded.The receiver operating characteristic (ROC) curve was used to evaluate the prognostic value of urinary NGAL,KIM-1 and APACHE Ⅱ scores in patients with sepsis complicated with AKI.Results The urinary NGAL [(970.2±705.2) vs (612.5±415.4),ng/mL],KIM-1 [(62.6 ±12.4) vs (28.8±7.2),ng/L] and APACHE Ⅱ score [(26.8±8.3) vs (17.9±6.2),score] in the death group were significantly higher than those in the survival group (P<0.05).ROC curve analysis showed that the optimal cut-off values of urinary NGAL,KIM-1 and APACHEⅡ scores for predicting AKI mortality were 805.26 ng/mL,50.35 ng/L and 23.90 points,respectively.Combined use of the three indicators had higharea under the curve (0.937,95% CI 0.885~0.987),sensitivity (96.3%) and specificity (88.0%) in predicting AKI mortality in sepsis patients were higher.Conclusions Urinary NGAL,KIM-1 and APACHE Ⅱ scores have good predictive value in evaluating the mortality of sepsis patients complicated with AKI,and increase accuracy of prognostic evaluation in patients with sepsis complicated with AKI.
作者
王元真
孙丽春
赵汉儒
WANG Yuan-zhen;SUN Li-chun;ZHAO Han-ru(Department of nephrology,Central Hospital of Western Hainan,Zhanzhou 571799,China)
出处
《临床肾脏病杂志》
2019年第5期322-325,共4页
Journal Of Clinical Nephrology
基金
海南省医学科研基金资助(17A600073)
