尿KIM-1、L-FABP联合检测在重症肺炎并发急性肾损伤早期诊断中的意义

目的探讨尿肾损伤分子1(KIM-1)和肝型脂肪酸结合蛋白(IL-FABP)在重症肺炎急性肾损伤(AKI)中的水平变化及其对早期诊断的意义。方法选择入住南翔医院ICU及急诊内科的重症肺炎患者87例,留取血液、尿液标本,并记录尿量。采用酶联免疫吸附测定法(enzyme-linked immunosorbent assay,ELISA)检测尿KIM-1和L-FABP,运用受试者工作特征(ROC)曲线及曲线下面积(AUC)进行分析。结果共入组的87例患者,年龄(66.53±17.77)岁,其中重症肺炎非AKI者58例,重症肺炎AKI者29例。其中AKI组年龄更大,合并COPD比例更高,入院时CRP及PCT更高,但是两组患者其基线肌酐数值无明显差异。AKI组在入院时危重病评分及死亡率更高。应用常用炎症指标C和危重病评分对重症肺炎患者发生AKI进行预测,结果发现AUC依次为.CURB-65>PCT>SOFA评分>APACHEII评分>CRP。两组患者尿L-FABP水平在AKI发生前48h即有差异,尿KIM-1水平在发生AKI前24h有差异。尿KIM-1(-24 h)、L-FABP(-24 h)及其联合使用,其AUC分别为0.791、0.784和0.823。KIM-1(-24 h)、L-FABP(-24 h)、CURB-65三者联合预测AKI,当cut-off>0.6092时,敏感性为0.690,特异性为0.983。结论重症肺炎患者在AKI发生前24~48h其尿KIM-1、L-FABP即出现升高,具有早期诊断AKI的价值。KIM-1(-24 h)、L-FABP(-24 h)、CURB-65三者联合预测AKI,其价值更高。

Significance of combined detection of urine KIM-1 and L-FABP in early diagnosis of severe pneumonia with acute renal injury

Objective To investigate the changes of urinary and Kim-1 and L-FABP levels in severe pneumonia with AKI and their significance in early diagnosis.Methods 87 patients with severe pneumonia admitted to EICU and Emergency internal medicine ward of Nanxiang Hospital were selected.Blood and urine samples were collected daily and daily urine volume were recorded.ELISA was used to detect urinary KIM-1 and L-FABP.The ROC curve and the AUC were used to evaluate the early diagnostic value of urinary KIM-1 and L-FABP in severe pneumonia.Results 87 patients were enrolled,aged 66.53±17.77.Among them,58 were non-AKI patients with severe pneumonia and 29 were AKI patients with severe pneumonia.Among them,A KI group was older and had a higher proportion of COPD.CRP and PCT were higher in AKI group at admission,but there was no significant difference in baseline creatinine values between the two groups.The initial critical illness score and mortality rate were higher in AKI group.Commonly used inflammatory markers and critical ilness score were used to predict AKI in severe pneumonia patients,Results shows that the AUC ranked as CURB-65>PCT>SOFA>APACHEⅡ>CRP.The levels of urinary L-FABP were different 48 hours before AKI onset and 24 h for KIM-1.The AUC of urine KIM-1(-24 h),L-FABP(-24 h)and their combination were 0.791,0.784 and 0.823,respectively.KIM-1(-24 h),L-FABP(-24 h)and CURB-65 were combined to predict AKI.When cut-off>0.6092,the sensitivity and speiflcity were 0.690 and 0.983.Conelusion The urinary KIM-1 and L-FABP of severe pneumonia patients inereased 24~48 h before the onset of AKI,which has the value of early diagnosis of AKI.KIM-1(-24 h),L-FABP(-24 h)and CURB-65 are combined to predict AKI,which has higher value.