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中华危重症医学杂志(电子版) ›› 2016, Vol. 09 ›› Issue (04) : 250 -255. doi: 10.3877/cma.j.issn.1674-6880.2016.04.008

所属专题: 文献

论著

尿肾损伤分子1和中性粒细胞明胶酶相关脂质运载蛋白对脓毒症合并急性肾损伤患者早期连续性肾脏替代治疗的预测价值
徐建国1,(), 金献冠1, 李钰1   
  1. 1. 325000 温州市人民医院ICU
  • 收稿日期:2016-03-11 出版日期:2016-08-01
  • 通信作者: 徐建国
  • 基金资助:
    温州市2014年公益性科技计划项目(Y20140494)

Prognostic value of kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin on early continuous renal replacement therapy in sepsis patients with acute kidney injury

Jianguo Xu1,(), Xianguan Jin1, Yu Li1   

  1. 1. Department of Intensive Care Unit, the People's Hospital in Wenzhou, Wenzhou 325000, China
  • Received:2016-03-11 Published:2016-08-01
  • Corresponding author: Jianguo Xu
  • About author:
    Corresponding author: Xu Jianguo, Email:
引用本文:

徐建国, 金献冠, 李钰. 尿肾损伤分子1和中性粒细胞明胶酶相关脂质运载蛋白对脓毒症合并急性肾损伤患者早期连续性肾脏替代治疗的预测价值[J/OL]. 中华危重症医学杂志(电子版), 2016, 09(04): 250-255.

Jianguo Xu, Xianguan Jin, Yu Li. Prognostic value of kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin on early continuous renal replacement therapy in sepsis patients with acute kidney injury[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2016, 09(04): 250-255.

目的

探讨尿肾损伤分子1(KIM-1)及中性粒细胞明胶酶相关脂质运载蛋白(NGAL)对脓毒症合并急性肾损伤(AKI)患者早期连续性肾脏替代治疗(CRRT)的预测价值。

方法

选择温州市人民医院2012年7月至2015年11月收治的脓毒症合并AKI的患者159例,根据是否CRRT治疗,分为非CRRT组(92例)及CRRT组(67例)。收集所有患者尿液标本,采用酶联免疫吸附测定法检测尿KIM-1及NGAL水平。对两组患者的一般资料进行比较,并采用Logistic回归分析影响脓毒症合并AKI患者早期CRRT治疗的相关因素。同时通过受试者工作特征曲线(ROC)评价尿KIM-1、NGAL浓度在预测脓毒症AKI患者需CRRT的价值。

结果

非CRRT组及CRRT组患者在年龄[(65 ± 18)岁vs.(77 ± 11)岁,t=26.380,P<0.001]、腹腔感染[8/92 vs. 23/67,χ2=16.228,P<0.001]、四肢皮肤软组织感染[19/92 vs. 2/67,χ2=10.556,P<0.001]、冠心病[46/92 vs. 50/67,χ2=9.828,P=0.002]、糖尿病[24/92 vs. 38/67,χ2=15.289,P<0.001]、慢性心功能不全[36/92 vs. 52/67,χ2=23.229,P<0.001]、气管插管留置>48 h [32/92 vs. 35/67,χ2=5.239,P=0.024]、急性病生理学和长期健康评价(APACHE)Ⅱ评分[(16 ± 6)分vs.(22 ± 5)分,t=40.671,P<0.001]、尿KIM-1 [(17 ± 4)ng·L-1·Cr-1 vs.(29 ± 19)ng·L-1·Cr-1t=34.849,P<0.001]及NGAL水平[(5.7 ± 1.4)ng·L-1·Cr-1 vs.(7.7 ± 1.6)ng·L-1·Cr-1t=65.483,P<0.001]的比较差异均有统计学意义。Logistic回归分析统计结果显示:糖尿病、慢性心功能不全、APACHEⅡ评分>18分、尿KIM-1浓度>21.0 ng·L-1·Cr-1及NGAL浓度>6.5 ng·L-1·Cr-1是影响脓毒症AKI患者选择CRRT治疗的相关因素;尿KIM-1、NGAL水平及两者联合预测患者需CRRT治疗的ROC曲线下面积分别为:0.783(95%CI:0.702~0.864,P<0.05)、0.819(95%CI:0.753~0.886,P<0.05)及0.867(95%CI:0.810~0.923,P<0.05);NGAL及KIM-1的约登指数分别为0.465和0.502,两者联合后,约登指数为0.603。

结论

尿KIM-1及NGAL水平对早期预测脓毒症合并AKI患者介入CRRT治疗有一定的应用价值,且两者联合检测更具有预测价值。

Objective

To evaluate the prognostic value of kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) on early continuous renal replacement therapy (CRRT) in sepsis patients with acute kidney injury (AKI).

Methods

A total of 159 sepsis patients with AKI in the People's Hospital in Wenzhou from July 2012 to November 2015 were divided into the non-CRRT group (92 cases) and CRRT group (67 cases). Within 24 hours after the diagnosis, the urine samples were collected and the urinary KIM-1 and NGAL levels were measured by enzyme-linked immunosorbent assay. At the same time, the general data of the two groups were compared and the influence factors related to sepsis patients with AKI undergoing early CRRT were analyzed by Logistic regression. The receiver operating characteristic (ROC) was performed to evaluate the early predictive value of urinary KIM-1 and NGAL in septic AKI patients with CRRT.

Results

The age [(65 ± 18) vs.(77 ± 11) years, t=26.380, P<0.001], abdominal infection [8/92 vs. 23/67, χ2=16.228, P<0.001], limb skin and soft-tissue infections [19/92 vs. 2/67, χ2=10.556, P<0.001], coronary heart disease [46/92 vs. 50/67, χ2=9.828, P=0.002], diabetes [24/92 vs. 38/67, χ2=15.289, P<0.001], chronic cardiac insufficiency [36/92 vs. 52/67, χ2=23.229, P<0.001], endotracheal intubation >48 h [32/92 vs. 35/67, χ2=5.239, P=0.024], acute physiology and chronic health evaluation (APACHE) Ⅱscores [16 ± 6 vs. 22 ± 5, t=40.671, P<0.001], KIM-1 [(17 ± 4) ng·L-1·Cr-1 vs. (29±19) ng·L-1·Cr-1, t=34.849, P<0.001] and NGAL [(5.7 ± 1.4) ng·L-1·Cr-1 vs. (7.7 ± 1.6) ng·L-1·Cr-1, t=65.483, P<0.001] all showed singificant differences between the non-CRRT group and CRRT group. Logistic regression also showed that diabetes, chronic cardiac insufficiency, APACHE Ⅱ score >18, KIM-1 >21.0 ng·L-1·Cr-1 and NGAL >6.5 ng·L-1·Cr-1 were related factors in sepsis patients with AKI undergoing CRRT. Meanwhile, the area under curve (AUC) in ROC of KIM-1, NGAL and combination of the two for early CRRT were 0.783 (95%CI: 0.702-0.864, P<0.05), 0.819 (95%CI: 0.753-0.886, P<0.05) and 0.809 (95%CI: 0.730-0.882, P<0.05), respectively. The Youden index of KIM-1 and NGAL were 0.465, 0.502, and after the combination, the Youden index was up to 0.603.

Conclusions

Urinary NGAL and KIM-1 have a certain predictive value on early CRRT in sepsis patients with AKI. If both indices were joint detection, the accuracy of prediction will be improved.

表1 两组脓毒症合并急性肾损伤患者一般资料的比较
组别 例数 性别(例,男/女) 年龄(岁,±s 病因分类[例(%)] 基础疾病[例(%)]
肺部感染 腹腔感染 胆道感染 尿路感染 四肢皮肤软组织感染 冠心病 高血压 糖尿病 慢性心功能不全
非CRRT组 92 51/41 65 ± 18 40(43.5) 8(8.7) 13(14.1) 12(13.0) 19(20.7) 46(50.0) 66(71.7) 24(26.1) 36(39.1)
CRRT组 67 44/23 77 ± 11 28(41.8) 23(34.3) 9(13.4) 5(7.1) 2(3.0) 50(74.6) 40(59.7) 38(56.7) 52(77.6)
t/χ2 ? 1.689 26.380 0.045 16.228 0.016 1.264 10.556 9.828 2.528 15.289 23.229
P ? 0.252 <0.001 0.872 <0.001 1.000 0.308 0.001 0.002 0.127 <0.001 <0.001
组别 例数 气管插管>48 h[例(%)] 深静脉导管>48 h[例(%)] 导尿管>48 h[例(%)] 尿量(ml·h-1· kg-1±s 平均动脉压(mmHg,±s 心率(次/min,±s
非CRRT组 92 32(34.8) 47(51.1) 68(73.9) 1.4 ± 0.5 81 ± 17 99 ± 22
CRRT组 67 35(52.2) 32(47.8) 34(50.7) 1.3 ± 0.4 83 ± 17 96 ± 21
t/χ2 ? 5.239 0.172 0.970 1.200 0.686 1.070
P ? 0.024 0.749 0.349 0.275 0.409 0.302
组别 例数 休克指数(±s 肌酐(μmol/L,±s 白细胞(× 109/L,±s APACHEⅡ评分(分,±s KIM-1(ng·L-1·Cr-1±s NGAL(ng·L-1· Cr-1±s
非CRRT组 92 1.0 ± 0.3 127 ± 29 14.9 ± 3.0 16 ± 6 17 ± 4 5.7 ± 1.4
CRRT组 67 0.9 ± 0.3 133 ± 33 15.4 ± 2.4 22 ± 5 29 ± 19 7.7 ± 1.6
t/χ2 ? 0.133 1.571 1.231 40.671 34.849 65.483
P ? 0.715 0.212 0.269 <0.001 <0.001 <0.001
表2 脓毒症合并急性肾损伤患者早期CRRT治疗的Logistic回归分析
图1 KIM-1、NGAL及两者联合指标预测脓毒症急性肾损伤患者需CRRT治疗的ROC曲线。注:KIM-1:尿肾损伤分子1(kidney injury molecule-1);NGAL:中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin);CRRT:连续性肾脏替代治疗(continuous renal replacement therapy);ROC:受试者工作特征曲线(receiver operating characteristic)
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