尿生物标志物在儿童急性肾损伤早期诊断中的作用研究

目的：评价尿NGAL,KIM-1和β2-MG在儿童不同基础疾病导致的AKI早期诊断中的价值。方法：我们做的是前瞻性临床研究,检测在我院儿科门急诊不同疾病患儿尿中性粒细胞明胶酶相关的脂质运载蛋白（NGAL）,肾脏损伤因子-1（KIM-1）和-β2微球蛋白（β2-MG）的水平,以AKIpRIFLE为分期标准将入选患儿分组,比较尿NGAL,KIM-1和β2-MG在儿童急性肾损伤诊断中的敏感性,特异性,阳性似然比,阴性似然比,分析比较这3个指标在急性肾损伤早期诊断中的作用。结果：入选262例患儿中,23例患儿可诊断为AKI,15例患儿为AKI-R期,8例患儿为AKI-I期,入选患儿中没有AKI-F期,23例患儿中只有5例临床有AKI的诊断。尿NGAL,KIM-1和β2-MG的水平在血肌酐没有明显升高之前已经升高,随着肾损伤的加重升高的更明显,不同组间差异有统计学意义。尿NGAL和β2-MG在预测儿童AKI的早期诊断方面好于尿KIM-1（AUC〉0.8）。结论：尿NGAL,KIM-1和β2-MG均可以在Scr没有升高之前预测儿童AKI的发生,是儿童AKI的早期生物标志物。尿NGAL在早期预测不同基础疾病可能发生AKI方面好于其他两项指标。

The Function of Urinary Biomarkers to Predict Acute Kidney Injury in Children

Objective：To test the ability of urinary acute kidney injury（AKI）biomarkers to predict AKI presence and severity.Methods：This research is a prospective clinical study in pediatric patients presenting to clinic and emergency center.AKI was defined by the modified pediatric RIFLE（pRIFLE）system.Urinary neutrophil Gelatinase-Associated Lipocalin（NGAL）,kidney injury molecule-1（KIM-1）and β2-MG were quantified by the method of ELISA and were compared with each other in the prediction of pediatric AKI.Results：23 children of enrolled 262 patients had AKI by pRIFLE,yet 18 of these 23 AKI cases may have been missed since Scr was within normal range.Urinary NGAL,KIM-1 and β2-MG all demonstrated good to excellent accuracy to predict patients with AKI,especially urinary NGAL and β2-MG（AUC0.8）.Conclusion：Our data suggest urinary NGAL,KIM-1 and β2-MG may serve well to detect AKI accurately,even in cases SCr levels are normal,especially NGAL.Further study is required to determine if these biomarkers can predict AKI development or progression in hospitalized patients.