新型生物标志物对脓毒症急性肾损伤的诊断价值比较

目的 比较中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、尿肾损伤分子-1(KIM-1)和血半胱氨酸蛋白酶抑制蛋白C(Cystatin C)对脓毒症急性肾损伤(AKI)的诊断价值.方法 采用随机对照前瞻性研究方法,选择自2011-01 ～2012-06入住绍兴市人民医院ICU的73例脓毒症患者.所有患者入院后分别测定血清NGAL (sNGAL)、血清Cystatin C(sCystatin C)、血清肌酐(sCr)、尿NGAL(uNGAL)、尿KIM-1(uKIM-1),计算APACHEⅡ评分、SOFA评分,随访记录28 d病死率.依据AKIN定义的AKI诊断标准判断患者是否发生AKI,将患者分为AKI组和非AKI组.绘制受试者工作特征曲线(ROC),计算各指标预测脓毒症肾损伤的曲线下面积(AUC),比较不同来源的三种新型生物标志物对脓毒症AKI的诊断效能.计量资料采用t检验或Mann-Whitney U检验,计数资料比较采用x2检验.结果 73例脓毒症患者中,非AKI组38例,AKI组35例,AKI组的APACHEⅡ评分、SOFA评分、sCr及28 d病死率均高于非AKI组(P分别＜0.05和＜0.01).sNGAL、sCystatin C、uNGAL、uKIM-1均与脓毒症AKI相关,AKI组各项检测指标均高于非AKI组,且差异有统计学意义(P＜0.05).各项指标的ROC曲线分析,uNGAL的AUC(0.933)最大,以118.5 ng/mL为截断值,其敏感度为92.6％,特异度为89.4％.结论 sNGAL、sCystatin C、uNGAL、uKIM-1均能预测脓毒症AKI的发生,其中uNGAL准确度最高.uNGAL可作为脓毒症AKI患者的早期诊断标志物.     

心钠肽、肾损伤分子 -1 在脓毒症发生急性肾损伤中的变化及意义简

目的探讨血心钠肽（ANP）、尿肾损伤分子-1（KIM-1）在脓毒症发生急性肾损伤中的动态变化及意义。方法选取自2012年1月至2012年8月在新疆石河子大学医学院第-附属医院ICU收治的45例脓毒症患者为研究对象,分别在第2h,6h、24h、48h采集血液及尿液标本用酶联免疫分析法（ELISA）检测ANP和KIM-1。根据脓毒症患者是否在住院期间发生急性肾损伤,分为脓毒症AKI组、脓毒症非AKI组进行对比分析。结果在ICU住院期间17例患者发生AKI,AKI发生率为37．78％。AKI组血ANP在2h,6h、24h、48h和尿KIM-1在6h、24h、48h明显高于非AKI组（P〈0．05）;2h血ANP和6h尿KIM-1与确诊AKI时24h血清肌酐（Scr）呈正相关（r=0．768,P=0．04l;r=0．674,P=0．032）。结论血ANP和尿l（IM-1较Scr更早出现升高,其水平变化可以反映肾损害的严重程度,可以预测脓毒症是否发生AKI。     

ANP及KIM-1在脓毒症患者发生急性肾损伤中的变化及意义

目的 探讨血心钠肽(ANP)及尿肾损伤分子-1(KIM-1)在脓毒症发生急性肾损伤(AKI)中的动态变化及意义.方法 选取自2012-01～2012-09在我院ICU收治的60例脓毒症患者为研究对象,分别在0、2、6、24、48 h采集血液及尿液标本,用ELISA法分别检测ANP和KIM-1.根据脓毒症患者是否在住院期间发生AKI,分为脓毒症AKI组、脓毒症非AKI组进行对比分析.结果 在ICU住院期间28例患者发生AKI,AKI发生率46.67％.AKI组血ANP在2、6、24、48 h和尿KIM-1在6、24、48 h高于非AKI组(P ＜0.05);2 h血ANP和6h尿KIM-1与确诊AKI时24h血清肌酐(sCr)呈正相关(r=0.959,P=0.000;r =0.938,P=0.000).2h血ANP和6h尿KIM-1的ROC曲线下面积(AUC)分别为0.865(95％ CI 0.772～0.957)和0.923(95％CI 0.854～0.992).结论 血ANP和尿KIM-1较sCr更早出现升高,其水平变化可以反映肾损害的严重程度,可以预测脓毒症是否发生AKI.     

尿NGAL和KIM-1及IL-18在脓毒症并发急性肾损伤中的早期诊断价值

目的:探讨尿肾损伤分子-1(KIM-1)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)及白细胞介素-18(IL-18)对脓毒症并发急性肾损伤(AKI)的早期诊断价值。方法:选取2017-01—2019-12期间本院收治的脓毒症患者216例,依据其是否发生AKI,分为AKI组(74例)和非AKI组(142例)。采用酶联免疫吸附法测定患者0h、12h、24h尿NGAL、KIM-1及IL-18水平。应用受试者工作特征(ROC)曲线分析不同时间点尿NGAL、KIM-1及IL-18水平对AKI的早期诊断价值。结果:在12h、24h时间点,AKI组尿NGAL、KIM-1及IL-18水平均明显高于非AKI组(P0.05)。ROC曲线分析显示,12h尿KIM-1、NGAL及IL-18水平诊断AKI的AUC分别为0.863(95%CI:0.812～0.917)、0.834(95%CI:0.778～0.892)、0.768(95%CI:0.713～0.830),其最佳截断值分别为653.70ng/ml、39.20pg/ml、23.60pg/ml。12h尿NGAL、KIM-1及IL-18三项联合诊断AKI的AUC(0.937,95%CI:0.883～0.992)最大,其敏感度和特异度最好,为94.5%和87.0%。Pearson相关分析显示,AKI患者尿12hNGAL水平与KIM-1及IL-18水平均呈正相关(r=0.736,r=0.658,P0.01),AKI患者尿24hNGAL水平与KIM-1及IL-18水平均呈正相关(r=0.694,r=0.617,P0.01)。结论:12h尿NGAL、KIM-1及IL-18水平在脓毒症并发AKI患者中明显升高,三项联合检测对AKI早期诊断的价值较高。     

中性粒细胞明胶酶相关脂质运载蛋白对脓毒症患者发生急性肾损伤的诊断研究北大核心CSCD

目的评价血清和尿中性粒细胞明胶酶相关载质蛋白（NGAL）对脓毒症患者发生急性肾损伤（AKI）的预测价值。方法本研究为前瞻性观察研究,于2014年7月1日至2014年12月31日在天津市人民医院、天津医院和天津南开医院三所医院进行,入选患者为不伴AKI的脓毒症患者。入选患者于入住重症监护室（ICU）后发生AKI者归入AKI组,未发生AKI者归入非AKI组。患者入住ICU后,立即采血、尿标本以及临床数据,于入住ICU后的12、24、36、48、60、72、84和96 h连续采集血清和尿液标本。血清和尿标本检测肌酐（Cr）和NGAL。符合正态分布的计量资料数据比较用成组t检验或重复测量的方差分析;非正态分布计量资料数据比较用Mann-Whitney U检验或Fridman检验。计数资料数据比较用Fisher精确概率法。用受试者工作曲线（ROC）分析血清NGAL（sNGAL）和尿NGAL（uNGAL）对AKI发生的预测价值。结果50例脓毒症患者入选,AKI组35例,非AKI组15例,两组患者年龄的中位数（四分位数）分别为AKI组73岁（66,83）岁,非AKI组60岁（47,82）岁。在各个时间点处,AKI组的uNGAL浓度显著高于非AKI组;而AKI组的sNGAL浓度只在AKI发生前的48 h和36 h高于非AKI组。AKI发生前48 h、36 h、24 h和12 h的uNGAL预测AKI发生的ROC曲线下面积（AuROC）分别为0.83（95%CI：0.70～0.97）、0.75（95%CI：0.59～0.91）、0.83（95%CI：0.70～0.95）和0.73（95% CI：0.60～0.88）。sNGAL只在AKI发生前的48 h和36 h具有预测AKI的能力,AuROC值分别为0.69（95%CI：0.51～0.88）和0.69（95%CI：0.52～0.87）。结论sNGAL和uNGAL均是预测AKI有效的早期生物标志物,但sNGAL预测AKI的价值稍逊于uNGAL。     

尿肾损伤分子-1和可溶性髓样细胞触发受体-1对脓毒症相关急性肾损伤的早期诊断价值

目的:探讨尿肾损伤分子-1(KIM-1)、可溶性髓样细胞触发受体1(sTREM-1)对脓毒症相关急性肾损伤(SA-AKI)的早期诊断价值。方法:选取2017-08—2019-05期间本院收治的脓毒症患者121例,依据其是否发生SA-AKI,分为AKI组(39例)和非AKI组(82例)。单因素和多因素Logistic回归分析临床资料确定SA-AKI发生的高危因素。采用酶联免疫吸附法测定患者0、12、24 h尿KIM-1和sTREM-1水平。应用受试者工作特征(ROC)曲线分析不同时间点尿KIM-1和sTREM-1水平对SA-AKI的早期诊断价值。结果:SA-AKI的发病率为33.23%(39/121)。与非AKI组相比,AKI组患者血SCr、尿KIM-1、尿sTREM-1和APACHEⅡ评分明显升高,差异具有统计学意义(P0.05)。多因素Logistic回归分析显示,SCr、尿KIM-1和尿sTREM-1是SA-AKI患者的独立危险因素。在12 h和24 h,AKI组尿KIM-1和sTREM-1水平均明显高于非AKI组,差异有统计学意义(P0.05)。与24 h尿KIM-1联合sTREM-1对AKI预测效能相比,12 h尿KIM-1联合sTREM-1具有更高的预测效能(Z=4.632,P0.05),其ROC曲线下面积为0.948(95%CI:0.907～0.989),其诊断灵敏度为93.58%,特异度为87.69%。结论:SA-AKI患者在12 h时尿KIM-1和sTREM-1表达水平明显升高,尿KIM-1和sTREM-1可以作为早期诊断SA-AKI的有效生物标志物,联合检测具有更高的预测效能。     

尿金属蛋白酶组织抑制剂-2·胰岛素样生长因子结合蛋白-7对脓毒血症患者急性肾损伤和肾替代治疗的早期预测价值

目的探讨尿金属蛋白酶组织抑制剂-2(TIMP-2)·胰岛素样生长因子结合蛋白-7(IGFBP-7)对脓毒血症患者急性肾损伤(AKI)和肾替代治疗(RRT)的早期预测价值。方法选取121例脓毒血症患者和24例体检健康者,后者作为对照组。记录上述人群一般资料,检测并比较入院时的血肌酐(sCr)、乳酸脱氢酶(LDH)、C-反应蛋白(CRP)、降钙素原(PCT)、白细胞计数(WBC)、D-二聚体(D-D)、纤维蛋白原(Fib)、TIMP-2、IGFBP-7水平。检测脓毒血症患者入住ICU后6、12、24、36 h尿TIMP-2、尿IGFBP-7,计算尿TIMP-2·IGFBP-7。将所有脓毒血症患者根据是否发生AKI分为AKI组和非AKI组,采用受试者工作特征曲线(ROC)及曲线下面积(AUC)判断不同时间点尿TIMP-2·IGFBP-7对AKI的预测价值,确定最佳临界值,分析尿TIMP-2·IGFBP-7与AKI的关系。将AKI患者分为肾替代治疗(RRT)组和非RRT组,比较两组间尿TIMP-2·IGFBP-7,利用ROC曲线及AUC判断不同时间点尿TIMP-2·IGFBP-7对RRT的预测价值,确定最佳临界值。结果121例脓毒血症患者中发生AKI 45例。AKI组、非AKI组LDH、CRP、PCT、WBC、D-D、Fib水平均高于对照组(P<0.05),非AKI组序贯器官衰竭评估(SOFA)评分、血浆输注量、RBC输注量均低于AKI组,发病至入住ICU时间长于AKI组,差异均有统计学意义(P<0.05);入住ICU后6、12、24、36 h尿TIMP-2·IGFBP-7与AKI的发生呈正相关(r=0.206、0.383、0.415、0.462,均P<0.05),随着时间推移r增大。入住ICU后6、12、24、36 h尿TIMP-2·IGFBP-7用于预测AKI的AUC分别为0.740、0.788、0.795、0.877,最佳临界值分别为0.415、0.485、0.591、0.825 ng/(mL^2·10^3);RRT组尿TIMP-2·IGFBP-7高于非RRT组,入住ICU后6、12、24、36 h尿TIMP-2·IGFBP-7用于预测RRT的AUC分别为0.575、0.804、0.883、0.809,最佳临界值分别为0.518、0.825、0.917、1.015 ng/(mL^2·10^3)。结论尿TIMP-2·IGFBP-7是脓毒血症患者AKI发生和AKI患者行RRT的独立预测指标,具有较好的早期预测价值。     

先天性心脏病患儿术后检测尿NGAL、KIM-1对预测急性肾损伤的意义探讨

目的探讨先天性心脏病患儿术后检测尿液中性粒细胞明胶酶相关性载脂蛋白(NGAL)及肾损伤分子1(KIM-1)对预测急性肾损伤(AKI)的意义。方法选取2014年4月至2015年12月67例在该院进行心肺分流术的先天性心脏病患儿作为研究对象,依据pRIFLE标准分为AKI组(n=24)及非AKI组(n=43)。比较两组患儿手术前后血清肌酐、尿NGAL及尿KIM-1水平,并采用受试者工作特征曲线(ROC曲线)及ROC曲线下面积(AUC)评价NGAL及KIM-1预测小儿先天性心脏病术后AKI的价值。结果两组患儿术前,术后2、4h肌酐比较,差异无统计学意义(P0.05);但非AKI组患儿术后12、24、48h肌酐水平比较,明显低于AKI组(P0.05)。非AKI组患儿术后2、4、6、12h尿NGAL水平明显低于AKI组(P0.05),而两组患儿术后24h尿NGAL水平检测,差异无统计学意义(P0.05)。两组患儿术后2h尿KIM-1水平比较,差异无统计学意义(P0.05),非AKI组患儿术后4、6、12、24h尿KIM-1水平明显低于AKI组(P0.05)。单独检测尿NGAL水平协助诊断AKI的最佳时间点为术后12h,AUC为0.834(95%CI:0.631~0.912);单独检测KIM-1水平协助诊断AKI的最佳时间点为术后24h,AUC为0.871(95%CI:0.665~0.933);联合检测尿NGAL及KIM-1水平协助诊断AKI的最佳时间点为术后24h,AUC为0.913(95%CI:0.745~0.968)。结论小儿先天性心脏病术后检查尿NGAL及KIM-1水平对预测AKI的发生具有重要临床意义。     

NGAL和KIM-1在重症监护室危重患者早期急性肾损伤中的诊断价值

目的探讨尿液、血清中性粒细胞明胶酶转运蛋白(NGAL)和尿肾损伤分子-1(KIM-1)在重症监护室(ICU)危重症患者急性肾损伤(AKI)中的早期诊断价值。方法选取2010年6月至2011年5月本院以各种原发病于ICU病房治疗,且继发AKI的危重症患者23例,同期于ICU治疗的非AKI患者24例和健康者21例,用定量酶联免疫吸附试验(ELISA)检测尿液、血清NGAL和尿KIM-1水平,用常规生化方法检测血清尿素氮(BUN)、肌酐(Cr),用乳胶增强免疫比浊法检测血清胱抑素C(Cys C)。健康对照组、AKI患者入院时,AKI患者组、ICU非AKI患者组组间比较采用两独立样本t检验;应用受试者操作特征曲线(ROC曲线)评价各指标对AKI的诊断价值。结果 AKI患者组血清NGAL、尿NGAL、尿KIM-1、BUN、Cr和Cys C水平显著高于健康对照组,差异有统计学意义(P<0.01);AKI患者组与其入院时各研究指标比较,血清NGAL、尿NGAL、尿KIM-1、BUN和Cr水平差异有统计学意义(P<0.01);AKI患者组与非AKI患者组间血清NGAL、尿NGAL、尿KIM-1和Cr水平差异有统计学意义(P<0.01);血清NGAL、尿液NGAL、尿液KIM-1、Cr、Cys C、BUN的ROC曲线下面积依次为1.00、0.97、1.00、0.98、0.98、0.99。结论 AKI患者组与其他各研究组间血清NGAL、尿NGAL、尿KIM-1水平差异有统计学意义,血清NGAL、尿NGAL、尿KIM-1作为新的肾损伤标志物,对AKI具有早期诊断价值。     

肾损伤分子-1在创伤导致急性肾损伤早期诊断中的意义

目的观察肾损伤分子-1（Kidney Injury Molecule-1,KIM-1）在急性肾损伤（acute kidney injury,AKI）患者尿液中的变化,探讨在早期诊断中的意义。方法收集骨科和ICU住院的创伤患者,采用ELISA方法检测血或尿中KIM-1含量,采用速率散射比浊发检测尿白蛋白（albumin,Alb）、α1-微球蛋白（α1-microglobulin,α1-MG）。结果与健康对照组相比,1期、2期、3期AKI组,尿KIM-1均明显升高（P〈0.05）,其中2期、3期AKI组尿KIM-1明显高于1期AKI（P〈0.05）,尿KIM-1与α1-MG正相关。结论 AKI发生时,检测尿KIM-1有助于AKI的早期诊断和反应肾小管损伤。     

Plasma and urine neutrophil gelatinase-associated lipocalin in the diagnosis of new onset acute kidney injury in critically ill patients

Introduction

Neutrophil gelatinase-associated lipocalin (NGAL) has been demonstrated to be a useful early diagnostic biomarker of acute kidney injury (AKI) where the timing of the insult is certain. However, NGAL is not well validated in adult critical care practice because of indeterminate timing of injury. Therefore, we sought to establish the predictive ability of both urine and plasma NGAL to detect AKI in ICU patients.

Method

This prospective observational study was performed in a busy large district general hospital mixed surgical-medical ICU in Reading, UK. Consecutive adult admissions to the ICU, with absence of chronic kidney disease, renal transplant or AKI as defined by RIFLE criteria were included. Blood and urine specimens were collected at admission and every 24 hours until 72 hours and tested for NGAL. The purpose of the study was to assess whether urinary NGAL (uNGAL) or plasma NGAL (pNGAL) can predict the occurrence of AKI at an earlier point of time than the conventional markers, that is creatinine and urine output as is used in RIFLE criteria.

Results

Over a 12-month period, 194 patients were enrolled. In total, 59 (30.4%) patients developed AKI. The admission pNGAL and uNGAL were significantly higher in the patients who developed AKI compared to the non-AKI patients (436 ng/mL (240, 797) versus 168 ng/mL (121.3, 274.3) P <0.001 and 342 ng/mL (61.5, 1,280) versus 34.5 ng/mL (11.5, 107.75) P <0.001 respectively). Hospital mortality was higher in the AKI group (17% versus 4%). Plasma NGAL performed fairly on admission (AUROC 0.77) and thereafter performance improved at 24 and 48 hours (AUROC 0.88 and 0.87) following ICU admission. Urine NGAL had a fair predictive value on admission (AUROC 0.79) and at 24 hours (AUROC 0.78) and was good at 48 hours (AUROC 0.82).

Conclusions

In critically ill patients without pre-existing kidney disease, both pNGAL and uNGAL measured at admission can predict AKI (defined by RIFLE criteria) occurrence up to 72 hours post-ICU admission and their performance (AUROC) was fair. The accuracy of NGAL appeared to improve slightly as patients progressed through their ICU stay. Serial measurements of NGAL (both pNGAL and uNGAL) may be of added value in an ICU setting to predict the occurrence of AKI.     

Neutrophil gelatinase-associated lipocalin in adult septic patients with and without acute kidney injury

Purpose

To study the impact of inflammation/sepsis on the concentrations of neutrophil gelatinase-associated lipocalin (NGAL) in plasma and urine in adult intensive care unit (ICU) patients and to estimate the predictive properties of NGAL in plasma and urine for early detection of acute kidney injury (AKI) in patients with septic shock.

Methods

Sixty-five patients admitted to the general ICU at the Karolinska University Hospital Solna, Sweden, with normal plasma creatinine were assessed for eligibility. Twenty-seven patients with systemic inflammatory response syndrome (SIRS), severe sepsis, or septic shock without AKI and 18 patients with septic shock and concomitant AKI were included in the final analysis. Plasma and urine were analyzed twice daily for plasma NGAL (pNGAL), C-reactive protein (CRP), procalcitonin, myeloperoxidase, plasma cystatin C, plasma creatinine, urine NGAL (uNGAL), urine cystatin C, and urine α1-microglobulin.

Results

Of the 45 patients, 40 had elevated peak levels of pNGAL. Peak levels of pNGAL were not significantly different between septic shock patients with and without AKI. Peak levels of uNGAL were below the upper reference limit in all but four patients without AKI. uNGAL was a good predictor (area under ROC 0.86) whereas pNGAL was a poor predictor (area under ROC 0.67) for AKI within the next 12 h in patients with septic shock.

Conclusions

pNGAL is raised in patients with SIRS, severe sepsis, and septic shock and should be used with caution as a marker of AKI in ICU patients with septic shock. uNGAL is more useful in predicting AKI as the levels are not elevated in septic patients without AKI.     

联合检测尿NGAL、KIM-1对危重患儿急性肾损伤的临床意义

目的:探讨联合检测尿NGAL、KIM-1在判断重症患儿急性肾损伤(AKI)病情及预后中的作用。方法:以我院肾内科、PICU和健康体检儿童为观察对象,分为重症AKI组,重症非AKI组,CKD组和健康对照组,比较各组的血肌酐(sCr)和尿NGAL、尿KIM-1水平。结果:重症AKI组尿NGAL、KIM-1较重症非AKI组、CKD组、健康对照组明显升高(P0.05),重症非AKI组、CKD组、健康对照组各组间差别无统计学意义(P0.05)。尿KIM-1联合尿NGAL的峰值升高倍数和肾预后呈正相关,和CCr呈负相关关系。结论:尿NGAL和尿KIM-1水平与重症患儿AFI严重程度及肾预后有关。     

Diagnostic value of neutrophil gelatinase-associated lipocalin,cystatin C,and soluble triggering receptor expressed on myeloid cells-1 in critically ill patients with sepsis-associated acute kidney injury

IntroductionNeutrophil gelatinase-associated lipocalin (NGAL), cystatin C (Cys-C), and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) are novel diagnostic biomarkers of acute kidney injury (AKI). We aimed to determine the diagnostic properties of these biomarkers for detecting AKI in critically ill patients with sepsis.MethodsWe divided 112 patients with sepsis into non-AKI sepsis (n = 57) and AKI sepsis (n = 55) groups. Plasma and urine specimens were collected on admission and every 24 hours until 72 hours and tested for NGAL, Cys-C, and TREM-1 concentrations. Their levels were compared on admission, at diagnosis, and 24 hours before diagnosis.ResultsBoth plasma and urine NGAL, Cys-C, and sTREM-1 were significantly associated with AKI development in patients with sepsis, even after adjustment for confounders by using generalized estimating equations. Compared with the non-AKI sepsis group, the sepsis AKI group exhibited markedly higher levels of these biomarkers at diagnosis and 24 hours before AKI diagnosis (P <0.01). The diagnostic and predictive values of plasma and urine NGAL were good, and those of plasma and urine Cys-C and sTREM-1 were fair.ConclusionPlasma and urine NGAL, Cys-C, and sTREM-1 can be used as diagnostic and predictive biomarkers for AKI in critically ill patients with sepsis.     

联合标志物检测在成人心脏手术后早期急性肾损伤中的诊断价值

目的探讨尿中性粒细胞明胶酶相关载脂蛋白（NGAL）、尿肾损伤分子-1（Kim-1）、尿N-乙-p—D-氨基葡萄糖苷酶（NAG）、尿胱蛋白酶抑制剂C（CystC）在成人心脏手术后急性肾损伤（AKI）早期诊断的敏感性及联合应用的临床价值。方法选择2010年1月至2011年6月在我院心脏外科行心脏手术的住院患者105例,并收集手术前和手术后24、48、72h的血、尿标本,分别测定尿NGAL、Kim-1、NAG、CystC及血肌酐,血肌酐较基础值增加t〉50％的65例为AKI组,其余40例为非AKI组,观察两组患者尿NGAL、Kim-1、NAG、CystC的变化。尿NGAL、Kim-1、CystC测定采用酶联免疫法,尿NAG测定采用对硝基苯酚（PNP）比色法,血肌酐采用比浊法检测。并以受试者工作特征曲线及曲线下面积（AUC）评价各项标志物单独和联合应用时诊断AKI的价值。结果两组患者术前血肌酐及尿NGAL、KIM-1、NAG及CystC比较差异均无统计学意义（P均〉0．05）,AKI组的各项生物学标志物分别在术后24、48、72h较非AKI组升高,差异存在统计学意义（P均〈0．001）。与术前比较,AKI组尿NAG、CystC、NGAL、KIM-1术后24、48、72h明显升高,差异均有统计学意义（P均〈0．001）,联合以上4种尿生物标志物的最佳诊断时间点为术后48h,得到的AUC为0．901（95％C10．769～0．938）。结论心脏手术后AKI患者各项生物学标志物在术后不同的时间点显著升高,联合标记物的检测可以作为成人心脏手术后AKI的早期诊断方法。     

Neutrophil gelatinase-associated lipocalin levels during the first 48 hours of intensive care may indicate upcoming acute kidney injury

PurposeThe recognition of acute kidney injury (AKI) as early as possible is important in the intensive care unit. This study proposes that serum and urine levels of neutrophil gelatinase-associated lipocalin (NGAL) may be used for this purpose.MethodsOne hundred and seven critically ill adult patients with no previous renal failure were included. NGAL levels were measured during the first 48 hours after admission; NGAL levels were followed for 7 days and classified based on Risk, Injury, Failure, Loss, and End-Stage Renal Failure criteria.ResultsThe AKI incidence was 35.5%, and serum NGAL (sNGAL) and urinary NGAL (uNGAL) levels were higher in the AKI group. The area under the receiver operating characteristic curve was 0.76 (P < .001) for sNGAL and 0.75 (P < .001) for uNGAL. Seventy-one percent of AKI cases were observed within 48 hours, with 11 additional cases in the ensuing 7 days. The mean serum creatinine levels in the 11 patients were not different from non-AKI levels (P = .197), but the NGAL values were different, and the area under the receiver operating characteristic curve for sNGAL uNGAL was 1.00 (P = .014) and 0.93 (P = .02), respectively.ConclusionsMost AKI cases were diagnosed within the first 48 hours after admission, and NGAL was useful for predicting upcoming AKI.     

脓毒血症并发急性肾损伤早期诊断标志物的研究

目的 探讨NGAL预测脓毒血症后AKI的准确性.方法 收集74例脓毒血症患者诊断后不同时间点的血、尿标本,对其中17例AKI患者,采用固相夹心酶联免疫吸附法检测尿NGAL水平,胶乳颗粒增强的免疫透射浊度法测定Cys C的值,肌氨酸氧化酶法测定Set水平.同期的57例非AKI患者作为研究的对照.观察两组患者毒血症诊断后尿NGAL和Scr的动态变化.运用ROC曲线评价尿NGAL诊断AKI的准确性.结果 Scr基线值为(59.38±16.72)μmoL/L,诊断AKI的中位时间为脓毒血症确诊后的24(12,48)h,Scr为(100.35±28.26)μmol/L.本组脓毒血症后发生AKI17例,发生率为23%(17/74).脓毒血症AKI组患者2、4、6 h血清Cys C水平分别为(0.63±0.14)mg/L、(0.68±0.16)mg/L、(0.65±0.14)mg/L,与基线值(0.61±0.15)mg/L比较未见上升;8 h时,其血清Cys C值小幅升高为(0.85±0.22)mgs/L,但差异无统计学意义(t=1.63,P＞0.05);12、18、24、36、48及72 h等各时间点的血清Cys C值呈逐渐升高的趋势,与基线值比较差异均有统计学意义(t=2.81、2.98、3.05、3.11、3.38、3.17,P＜0.01).AKI组脓毒血症后2 h尿NGAL为(96.21 ±45.32)μg/L,显著高于基线值的(4.98±1.65)μg/L.随后,在2 h至48 h等各时间点,患者尿NGAL水平呈逐渐升高的趋势,与基线值比较差异均有统计学意义(t=2.74、2.83、2.91、3.04、3.15、3.22、3.31、3.45、3.57,P＜0.01).AKI组脓毒血症后各时间点尿NGAL水平均显著高于同期的非AKI组,差异有统计学意义(t=2.69、2.73、2.84、2.96、3.02、3.13、3.29、3.43、3.54、3.22,P＜0.01).用ROC曲线分析脓毒血症后2 h尿NGAL水平在AKI诊断中的准确性,得到ROC曲线下面积为0.935,95%的可信区间为0.683～0.971.当脓毒血症后2 h尿NGAL的cut-off值为50μg/L时,其在AKI诊断中的敏感度和特异度及准确性分别为94.4%、87.5%和96.8%.结论 脓毒血症后2 h尿NGAL水平可以准确地预测AKI的发生,其诊断AKI的时间早于Cys C和Scr.尿NGAL可作为脓毒血症后AKI的早期诊断标志物.