白细胞介素18、中性粒细胞明胶酶相关脂质运载蛋白和血清胱抑素C在呼吸衰竭合并急性肾损伤中的变化

目的探讨尿白细胞介素18（interleukin-18，IL-18）、中性粒细胞明胶酶相关脂质运载蛋白（neutrophilgelatinase-associatedlipocalin，NGAL）和血清胱抑素C（cystatinC，Cysc）在呼吸衰竭合并急性肾损伤（acutekidneyinjury，AKI）中的变化。方法收集我院呼吸衰竭患者125例，其中呼吸衰竭并发AKI患者35例（AKI组），呼吸衰竭未并发AKI患者90例（非AKI组）。检测全血细胞、血清CysC、血肌酐（SCr）、尿素氮（BUN）、血白蛋白水平、血气分析，检测尿NGAL和IL-18水平。结果2组患者间年龄、男女比例、动脉血氧分压、动脉血二氧化碳分压、血红蛋白、白蛋白的差异无统计学意义，而基础有高血压史比例的差异有统计学意义（P〈0．05）。AKI组估算肾小球滤过率（estimatedglomerularfiltrationrate，eGFR）低于非AKI组，差异有统计学意义（P〈0．05）；AKI组SCr、BUN、血清CysC、尿NGAL和II，18高于非AKI组，差异有统计学意义（P〈0．05）；Pearson相关分析显示AKI组尿IL-18、NGAL及血清CysC均与SCr具有相关性，与eGFR也具有相关性。多因素Logistic回归分析显示尿IL-18、NGAL、血清CysC升高是呼吸衰竭发生AKI的独立危险因素。结论尿IL-18、NGAL和血清CysC对诊断呼吸衰竭合并AKI有较高的准确性。

Change of IL-18, NGAL and Cys C in the diagnosis of acute kidney injury in respiratory failure

Objective To assess the values of interleukin-18 （IL-18）, urinary neutrophil gelati- nase-associated lipocalin（NGAL） and serum cystatin C（Cys C） in the diagnosis of respiratory failure complicated with acute kidney injury（AKI）. Methods 125 patients including 35 cases of AKI and 90 cases without AKI were collected in our hospital. Complete blood cells, the levels of serum Cys C, ser- um creatinine（SCr）, urea nitrogen, albumin and blood gas were analyzed. Urinary NGAL and IL 18 lev els were also determined. Results There were no statistically significant differences in age, male/fe- male ratio, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide, hemoglobin and albumin between two groups. There was significant difference in the hypertension proportion be- tween two groups（P〈0. 05）. In AKI group, the level of estimated glomerular filtration rate（eGFR） was significantly lower than that in non-AKI group（P〈0. 05）. The levels of SCr, urea nitrogen, urina- ry NGAL and urinary IL-18 in AKI group were significantly higher than those in non-AKI group with the difference being significant（P〈0. 05）. Pearson correlation analysis showed that the levels of urina- ry IL-18, urinary NGAL and serum Cys C in AKI group were positively correlated with SCr, but nega- tively correlated with eGFR （P〈0. 05）. Logistic regression analysis revealed that the increase of uri- nary IL-18, NGAL and serum Cys C were independent predictive biomarkers of AKI in respiratory failure. Conclusions Urinary IL-18,urinary NGAL and serum Cys C may be good performances in diag- nosis of AKI in respiratory failure.