不同生物学标志物对感染性急性肾损伤肾脏替代治疗的预测作用

doi:10.3969/j.issn.1006-7795.2013.02.005

首都医科大学学报 ›› 2013, Vol. 34 ›› Issue (2): 187-190.doi: 10.3969/j.issn.1006-7795.2013.02.005

不同生物学标志物对感染性急性肾损伤肾脏替代治疗的预测作用

蒋波, 姜利, 席修明

首都医科大学附属复兴医院重症医学科, 北京 100038

收稿日期:2013-01-16 出版日期:2013-04-21 发布日期:2013-04-17
通讯作者: 姜利 E-mail:jiangli@sina.com
基金资助:
首都医学发展科研基金资助项目(2009-3190)。

Biomarkers in predicting renal replacement therapy in acute septic kidney injury

JIANG Bo, JIANG Li, XI Xiuming

Intensive Care Unit, Fuxing Hospital, Capital Medical University, Beijing 100038, China

Received:2013-01-16 Online:2013-04-21 Published:2013-04-17
Supported by:
This study was supported by Scientific Research Foundation of Capital Medical University(2009-3190).

摘要/Abstract

摘要：

目的通过测定感染性急性肾损伤患者血清中性粒细胞胶原酶相关脂质运载蛋白(serum neutrophil gelatinase associated lipocalin,sNGAL)、尿中性粒细胞胶原酶相关脂质运载蛋白(urinary neutrophil gelatinase lipocalin,uNGAL)、尿肾损伤因子-1(urinary kidney injury molecule-1,uKIM-1)、尿白细胞介素-18(urinary interleukin-18,uIL-18)浓度,评价上述生物学标志物对感染性急性肾损伤患者接受肾脏替代治疗(renal replacement therapy,RRT)的预测作用。方法预计入住重症监护病房(intensive care unit,ICU)时间≥24 h的全身性感染患者,并于入组48 h内存在或出现急性肾损伤。测定患者入组时sNGAL、uNGAL、uIL-18、uKIM-1浓度。根据入组7日内是否应用RRT,将入组患者分为RRT组和非RRT组,比较2组间生物学标志物浓度的差异,绘制受试者工作特征曲线,评价生物学标志物对感染性急性肾损伤应用RRT的预测价值。结果入选感染性急性肾损伤患者45例,其中12例(26.7%)患者应用RRT。RRT组uNGAL显著高于非RRT组(912.0 ng/mL vs 218.0 ng/mL,P<0.001),2组间sNGAL、uIL-18、uKIM-1浓度差异无统计学意义。uNGAL预测感染性急性肾损伤患者应用RRT的曲线下面积为0.88。结论 uNGAL可能适合成为预测感染性急性肾损伤患者是否接受RRT的生物学标志物。

关键词: 全身性感染, 急性肾损伤, 肾脏替代治疗, 中性粒细胞胶原酶相关脂质运载蛋白, 肾损伤因子-1, 白细胞介素-18

Abstract:

Objective To evaluate whether the serum neutrophil gelatinase associated lipocalin(sNGAL), urinary neutrophil gelatinase lipocalin(uNGAL), urinary interleukin-18(uIL-18) or urinary kidney injury molecule-1(uKIM-1) can predict the need for renal replacement therapy(RRT)in patients with septic acute kidney injury(AKI). Methods A prospective observational study was conducted in patients with septic AKI whose expected ICU stay ≥24 h. AKI was defined by American Kidney Injury(AKIN) criteria during the 48 h after admission, while sNGAL, uNGAL, uIL-18 and uKIM-1 were determined at the enrollment. Test characteristics were calculated to assess the diagnostic performance of these biomarkers. Results Forty-five patients were studied, RRT was initiated in 12 patients with septic AKI in the first 7 days. Two groups were defined according to the need of RRT: RRT group(n=12) and non-RRT group(n=33). RRT group had higher median uNGAL level compared to non-RRT group(912.0 vs 218.0 ng/mL, P<0.001). The predicting performance for uNGAL was good(AUC 0.88), and that of sNGAL, uIL-18 and uKIM-1 was poor(AUC 0.68,0.69,0.67, respectively). Conclusion uNGAL might be a good biomarker for predicting the need of RRT in patients with septic AKI.

Key words: sepsis, acute kidney injury, renal replacement therapy, neutrophil gelatinase associated lipocalin, kidney injury molecule-1, interleukin-18

中图分类号:

蒋波, 姜利, 席修明. 不同生物学标志物对感染性急性肾损伤肾脏替代治疗的预测作用[J]. 首都医科大学学报, 2013, 34(2): 187-190.

JIANG Bo, JIANG Li, XI Xiuming. Biomarkers in predicting renal replacement therapy in acute septic kidney injury[J]. Journal of Capital Medical University, 2013, 34(2): 187-190.

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不同生物学标志物对感染性急性肾损伤肾脏替代治疗的预测作用

Biomarkers in predicting renal replacement therapy in acute septic kidney injury

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