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uKIM-1和uL-FABP对脓毒症患者急性肾损伤诊断价值的临床研究
作者:向礼芳1  宋玉燕2  邓建琼3 
单位:1. 重庆市公共卫生医疗救治中心急诊科, 重庆 400000;
2. 重庆市公共卫生医疗救治中心重症医学科, 重庆 400000;
3. 重庆市公共卫生医疗救治中心呼吸科, 重庆 400000
关键词:脓毒症 急性肾损伤 肾损伤分子-1 肝型脂肪酸结合蛋白 诊断 
分类号:R515.3
出版年·卷·期(页码):2020·39·第七期(845-850)
摘要:

目的:探讨尿液肾损伤分子-1(uKIM-1)和尿液肝型脂肪酸结合蛋白(uL-FABP)用于脓毒症患者急性肾损伤(AKI)的临床诊断价值。方法:纳入2016年2月至2018年2月就诊的脓毒症患者165例,根据入住ICU后24 h内是否发生AKI分为AKI组(n=81)及无AKI组(n=84)。使用酶联免疫分析(ELISA)方法检测患者uKIM-1及uL-FABP水平,ROC曲线分析这两个指标用于诊断AKI的临床价值。结果:AKI组uKIM-1水平[(6.16±2.71) vs. (3.37±1.29) ng·mg-1P<0.001]及uL-FABP水平[(465.11±193.54) vs. (255.51±87.99) ng·mg-1P<0.001]高于无AKI组。不同AKI分期患者中,AKI-3期uKIM-1和uL-FABP水平[(8.06±2.62 ng·mg-1)、(602.42±196.74) ng·mg-1]高于AKI-2期[(6.30±2.26) ng·mg-1、(449.27±148.77) ng·mg-1]及AKI-1期[(4.67±2.22) ng·mg-1、(379.29±171.89)ng·mg-1]。AKI组中,uKIM-1与血肝酐(sCr)(r=0.42,P<0.05)、乳酸(r=0.55,P<0.05)、序贯器官衰竭评估(SOFA)评分(rs=0.25,P<0.05)、AKI分期(rs=0.46,P<0.05)呈正相关,与肾小球滤过率估计值(eGFR)(r=-0.31,P<0.05)呈负相关;uL-FABP与sCr(r=0.34,P<0.05)、乳酸(r=0.68,P<0.05)、SOFA评分(rs=0.30,P<0.05)、AKI分期(rs=0.51,P<0.05)呈正相关,与eGFR(r=-0.23,P<0.05)呈负相关。在用于区别诊断AKI及非AKI患者时,uKIM-1、L-FABP及两者联合的AUC分别为0.83、0.81及0.88;在用于区别诊断AKI-3期与AKI-1/2期患者时,uKIM-1、u-FABP及两者联合的AUC分别为0.77、0.78及0.82。结论:脓毒症患者并发AKI时uKIM-1和uL-FABP升高,且两项指标用于诊断AKI分期具有较高的价值。

Objective:To investigate the diagnostic value of urinary kidney injury moleculer-1 (uKIM-1) and urinary liver fatty acid binding protein (uL-FABP) in spesis patients with acute kidney injury (AKI). Methods:A total of 165 spesis patients from February 2016 to February 2018 were involved, and they were divided into AKI group (n=81) and non-AKI group (n=84)according to whether AKI occured within 24 hours after ICU accepted. The uKIM-1 and uL-FABP levels were tested with enzyme-linked immunosorbent assay(ELISA). The correlations between uL-FABP (or uKIM-1) and clinical parameters were analyzed, and diagnostic values of uKIM-1 and uL-FABP for AKI were calculated by receiver operating characteristic curve(ROC).Results: The uKIM-1[(6.16±2.71)vs. (3.37±1.29)ng·mg-1, P<0.001]and uL-FABP[(465.11±193.54)vs. (255.51±87.99) ng·mg-1, P<0.001] levels in AKI group were both higher than those in non-AKI group. In different AKI stage, uKIM-1 and uL-FABP levels in patients of AKI-3 stage[(8.06±2.62)ng·mg-1, (602.42±196.74)ng·mg-1]were higher than those of AKI-2[(6.30±2.26)ng·mg-1, (449.27±148.77)ng·mg-1] and AKI-1[(4.67±2.22)ng·mg-1, (379.29±171.89)ng·mg-1] stage. In AKI group, the uKIM-1 level was positively correlated with sCr (r=0.42, P<0.05), lactic acid(r=0.55, P<0.05), SOFA score(rs=0.25, P<0.05) and AKI stage(rs=0.46, P<0.05), and negatively correlated with eGFR(r=-0.31, P<0.05); the uL-FABP level was positively correlated with sCr (r=0.34, P<0.05), lactic acid(r=0.68, P<0.05), SOFA score(r=0.30, P<0.05) and AKI stage (rs=0.51, P<0.05), and negatively correlated with eGFR(r=-0.23, P<0.05). Area under curve(AUC) of uKIM-1 and uL-FABP used for the diagnosis of AKI in spesispatients was 0.83 and 0.81, and AUC of uKIM-1 combined with uL-FABP was 0.88. AUC of uKIM-1 and uL-FABP used to distinguish AKI-3 from AKI-1/2 was 0.77 and 0.78, and AUC of uKIM-1 combined with uL-FABP was 0.82.Conclusion: The uKIM-1 and uL-FABP levels are evaluatedin sepsis patients with AKI, and the two parameters can be used for AKI stage diagnosis.

参考文献:

[1] KAUKONEN K M,BAILEY M,PILCHER D,et al.Systemic inflammatory response syndrome criteria in defining severe sepsis[J].N Engl J Med,2015,372(17):1629-1638.
[2] STEVENSON E K,RUBENSTEIN A R,RADIN G T,et al.Two decades of mortality trends among patients with severe sepsis:a comparative meta-analysis[J].Crit Care Med,2014,42(3):625-631.
[3] POOL R,GOMEZ H,KELLUM J A.Mechanisms of organ dysfunction in sepsis[J].Crit Care Clin,2018,34(1):63-80.
[4] 明颖,闫妹姝,刘秋霞,等.脓毒症患者血清降钙素原、炎症因子水平与APACHEⅡ、SOFA评分的相关性[J].现代医学,2020,48(3):357-361.
[5] FANG Y,DING X,ZHONG Y,et al.Acute kidney injury in a Chinese hospitalized population[J].Blood Purif,2010,30(2):120-126.
[6] KELLUM J A,PROWLE J R.Paradigms of acute kidney injury in the intensive care setting[J].Nat Rev Nephrol,2018,14(4):217-230.
[7] YIN C,WANG N.Kidney injury molecule-1 in kidney disease[J].Ren Fail,2016,38(10):1567-1573.
[8] WANG G,BONKOVSKY H L,DE LEMOS A,et al.Recent insights into the biological functions of liver fatty acid binding protein 1[J].J Lipid Res,2015,56(12):2238-2247.
[9] 中华医学会重症医学分会.中国严重脓毒症/脓毒性休克治疗指南(2014)[J].中华内科杂志,2014,54(6):557-581.
[10] PALEVSKY P M,LIU K D,BROPHY P D,et al.KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury[J].Am J Kidney Dis,2013,61(5):649-672.
[11] INNOCENTI F,TOZZI C,DONNINI C,et al.SOFA score in septic patients:incremental prognostic value over age,comorbidities,and parameters of sepsis severity[J].Intern Emerg Med,2017,13(3):405-412.
[12] ZHANG C F,WANG H J,TONG Z H,et al.The diagnostic and prognostic values of serum and urinary kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin in sepsis induced acute renal injury patients[J].Eur Rev Med Pharmacol Sci,2020,24(10):5604-5617.
[13] RANGASWAMY D,SUD K.Acute kidney injury and disease:Long-Term consequences and management[J].Nephrology,2018,23(11):969-980.
[14] TIAN L,SHAO X,XIE Y,et al.Kidney injury molecule-1 is elevated in nephropathy and mediates macrophage activation via the mapk signalling pathway[J].Cell Physiol Biochem,2017,41(2):769-783.
[15] XU Y,XIE Y,SHAO X,et al.L-FABP:A novel biomarker of kidney disease[J].Clin Chim Acta,2015,445:85-90.
[16] PANG H M,QIN X L,LIU T T,et al.Urinary kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin as early biomarkers for predicting vancomycin-associated acute kidney injury:a prospective study[J].Eur Rev Med Pharmacol Sci,2017,21(18):4203-4213.
[17] TU Y,WANG H,SUN R,et al.Urinary netrin-1 and KIM-1 as early biomarkers for septic acute kidney injury[J].Ren Fail,2014,36(10):1559-1563.
[18] GREENBERG J H,ZAPPITELLI M,JIA Y,et al.Biomarkers of AKI progression after pediatric cardiac surgery[J].J Am Soc Nephrol,2018,29(5):1549-1556.
[19] HISHIKARI K,HIKITA H,NAKAMURA S,et al.Urinary liver-type fatty acid-binding protein level as a predictive biomarker of acute kidney injury in patients with acute decompensated heart failure[J].Cardiorenal Med,2017,7(4):267-275.
[20] 王钊华,董自杰,韩彦洁,等.尿液中NGAL、L-FABP、KIM-1联合检测对儿童早期急性肾损伤的诊断价值[J].国际检验医学杂志,2018,39(3):286-288,292.

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