摘要
目的比较血清胱抑素C(cystatin C,CysC)、β_(2)微球蛋白(β_(2)-microglobulin,β_(2)-MG)、中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)和视黄醇结合蛋白(retinol-binding protein,RBP)对老年心肌梗死患者急性肾损伤(AKI)的诊断价值。方法回顾性纳入江南大学附属医院2021年1月至2022年1月收治的120例老年心肌梗死患者,收集患者入院当天血清CysC、β_(2)-MG、NGAL、RBP及肌酐水平,以及入院第3天的肌酐水平。按照KDIGO诊断标准将患者分为AKI组与无AKI组,比较两组间上述血清指标差异。绘制受试者工作特征(ROC)曲线,评估检测指标对AKI的诊断价值。分析各指标的血清水平与估算肾小球滤过率(eGFR)的相关性。结果与无AKI组相比,AKI组患者血清CysC、β_(2)-MG及NGAL的水平升高(P<0.05),RBP无明显变化。ROC曲线下面积(AUC)为CysC+β_(2)-MG+NGAL+RBP(0.941)>CysC+β_(2)-MG(0.910)>CysC(0.909)>β_(2)-MG(0.873)>NGAL(0.747)>RBP(0.729);CysC、β_(2)-MG及联合指标的灵敏度和特异度高于NGAL或RBP。CysC(r=﹣0.762,P<0.001)和β_(2)-MG(r=﹣0.683,P<0.001)的血清水平与eGFR负相关。剔除低射血分数(EF)值(<50%)后,AUC及相关性结果与剔除前一致。结论血清CysC和β_(2)-MG在老年心肌梗死患者中对AKI诊断价值优于NGAL及RBP,且与eGFR相关性良好;指标联合的诊断价值优于单指标。
Objective To compare the diagnostic values of cystatin C(CysC),β_(2)-microglobulin(β_(2)-MG),neutrophil gelatinase-associated lipocalin(NGAL)and retinol-binding protein(RBP)in acute kidney injury(AKI)in elderly patients with acute myocardial infarction(AMI).Methods One hundred and twenty older patients with AMI admitted to Affiliated Hospital of Jiangnan University were retrospectively enrolled from January 2021 to January 2022.The serum levels of CysC,β_(2)-MG,NGAL,RBP and creatinine on day 1,and creatinine level on day 3 after admission were collected.According to KDIGO diagnostic criteria,the patients were grouped into AKI group and non-AKI group.The receiver operating characteristics(ROC)curve was used to evaluate the diagnostic value of CysC,β_(2)-MG,NGAL,RBP in AKI,and the correlation between serum levels of each indicator and eGFR was analyzed.Results Compared with non-AKI group,the serum levels of CysC,β_(2)-MG and NGAL were significantly increased in AKI group(P<0.05),RBP level had no significant change.The areas under the ROC curve(AUC)of CysC+β_(2)-MG+NGAL+RBP,CysC+β_(2)-MG,CysC,β_(2)-MG,NGAL and RBP were 0.941,0.910,0.909,0.873,0.747 and 0.729,and the sensitivity and specificity of CysC orβ_(2)-MG were higher than NGAL or RBP.The serum levels of CysC(r=﹣0.762,P<0.001)andβ_(2)-MG(r=﹣0.683,P<0.001)were negatively correlated with eGFR.The consistent results of AUC and association were found after removing the low ejection fractio(EF)value(<50%).Conclusions Compared with NGAL and RBP,serum CysC andβ_(2)-MG levels may have higher values in diagnosing AKI in elderly patients with AMI and have greater associations with eGFR;the diagnostic value of multiple indicators is superior to the single.
作者
王芬
王晓彦
许周涛
高长征
WANG Fen;WANG Xiao-yan;XU Zhou-tao;GAO Chang-zheng(Department of Cardiology,Affiliated Hospital of Jiangnan University,Wuxi 214122,Jiangsu,China)
出处
《中国临床医学》
2023年第5期778-784,共7页
Chinese Journal of Clinical Medicine
基金
无锡市科学技术局面上项目(N20202019).
