摘要
目的:探讨新型生物标志物尿胰岛素样生长因子结合蛋白7(IGFBP7)联合尿金属蛋白酶2组织抑制剂(TIMP-2)在重症脑卒中相关急性肾损伤中的预测价值,同时评估AKI发生的危险因素。方法:选取神经重症病房(NCU)脑卒中患者99例,按照KDIGO标准对患者住院期间是否发生AKI进行诊断。收集患者入院时尿液标本,用酶联免疫吸附法(ELISA法)测定尿TIMP-2与IGFBP7浓度,动态监测纳入病例血清肌酐值。通过绘制受试者工作特征(ROC)曲线及计算曲线下面积(AUC)评价尿[TIMP-2]×[IGFBP7]对AKI的早期检测的价值。结果:AKI组患者尿IGFBP7、TIMP-2浓度及[TIMP-2]×[IGFBP7]均显著高于非AKI组(均P<0.05);脑卒中后24 h尿[TIMP-2]×[IGFBP7]预测AKI的AUC为0.898(95%CI:0.83~0.97,P<0.001,截断值为0.283,敏感度83.0%,特异度96.1%)。两组之间临床资料比较,可见AKI组使用了更多的甘露醇、机械通气等,有更多的出血性卒中,并且有更多的卒中史,更高的APACHEⅡ评分(P<0.05);多因素Logistic回归分析结果显示卒中史、使用甘露醇和APACHEⅡ评分是AKI发生的独立危险因素。结论:AKI发生的危险因素有出血性卒中、使用甘露醇、使用机械通气、卒中史及更高的APACHEⅡ评分,其中卒中史、使用甘露醇和更高的APACHEⅡ评分是AKI发生的独立危险因素。尿生物标志物尿[TIMP-2]×[IGFBP7]具有早期检测重症脑卒中患者AKI的价值,可以很好地预测重症脑卒中患者AKI的发生。
Objective:To investigate the predictive value of urinary novel biomarker insulin-like growth factor binding protein 7(IGFBP7)combined with tissue inhibitor of metalloproteinase 2(TIMP-2)on acute kidney injury(AKI)following severe stroke,and to evaluate the risk factors for AKI simultaneously.Methods:A total of 99 consecutive patients undergoing severe stroke in NCU were enrolled in this study.AKI was diagnosed according to KDIGO criteria.Urine samples were collected at admission,and the concentrations of TIMP-2 and IGFBP7 were detected by enzyme-linked immunosorbent assay(ELISA).Serum creatinine were dynamically monitored.The receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the detected value of the indicators.Results:Urinary IGFBP7 and TIMP-2 concentrations and urinary[TIMP-2]×[IGFBP7]in AKI group were significantly higher than those in non-AKI group(all P<0.05).The AUC of urinary[TIMP-2]×[IGFBP7]in predicting AKI at the end of 24 hours after stroke was 0.898(95%CI:0.830.97,P<0.001;the cut-off value:0.283,sensitivity:83.0%,specificity:96.1%).Compared with that respectively in non-AKI group,more cases with mannitol usage and mechanical ventilation,hemorrhagic stroke,and previous stroke history,and higher APACHEⅡscores were found in AKI group(P<0.05).Multivariate logistic regression analysis showed that previous stroke,use of mannitol,and APACHEⅡscore were independent risk factors for AKI.Conclusion:The risk factors for AKI include hemorrhagic stroke,use of mannitol,use of mechanical ventilation,previous stroke history,and higher APACHEⅡscore.Previous stroke,use of mannitol,and higher APACHEⅡscore were independent risk factors for AKI.Urinary biomarkers TIMP-2,IGFBP7,and urinary[TIMP-2]×[IGFBP7]are valuable for early AKI detection,and play a key role in predicting the occurrence of AKI in patients with severe stroke.
作者
张欢欢
於文丽
水华
王睿
徐志鹏
赵时雨
胡汉宁
胡洪涛
ZHANG Huanhuan;YU Wenli;SHUI Hua;WANG Rui;XU Zhipeng;ZHAO Shiyu;HU Hanning;HU Hongtao(Dept.of Nephrology,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China;Dept.of Neurology,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China;Dept.of Neurosurgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China;Dept.of Docimasiology,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China;Dept.of Intensive Care Unit,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China)
出处
《武汉大学学报（医学版）》
CAS
2023年第6期734-738,共5页
Medical Journal of Wuhan University
基金
武汉大学中南医院临床研发项目(编号:lcyf202005)。
