急性肾损伤相关生物学标志物在重症监护病房患者中的应用价值

目的：评估急性肾损伤(acute kidney injury，AKI)相关生物学标志物在重症监护病房(intensive care unit， ICU)患者AKI早期预测和诊断中的价值。方法：选择2014年1月至6月入住ICU的患者，收集相关临床资料、常规生化 结果，采用酶联免疫法检测血胱抑素C(serum cystatin C，sCys C)、血和尿中性粒细胞胶原酶相关脂质运载蛋白(serum neutrophil gelatinase-associated lipocalin，sNGAL and urinary neutrophil gelatinase-associated lipocalin，uNGAL)，尿肾损伤因 子-1(urinary kidney injury molecule-1，uKIM-1)、尿白细胞介素-18(urinary interleukin-18，uIL-18)、尿N-乙酰-β-D-葡萄糖苷 酶(urinary N-acetyl-beta-D-glucosaminidase，uNAG)，对比AKI和非AKI患者上述指标水平，采用受试者工作特征(receiver operating characteristic，ROC)曲线评估其诊断价值。结果：共收集176例患者，诊断AKI 71例，其中57例入ICU时即并 发AKI，14例入住24 h后发生AKI。AKI分级高者行肾替代治疗比例也增高，病死率18.8%(占死亡总数46.5%)。AKI患者 sCys C，sNGAL，uNGAL和uIL-18明显高于非AKI患者(P<0.05)，其中sCys C和uNGAL水平随AKI分级而升高。14例入住 24 h后发生AKI的患者其入ICU时sCys C，uNGAL，uIL-18，uKIM-1均值明显升高(P<0.05)；uNGAL，sCys C，uIL-18诊 断AKI对应敏感度和特异度分别为97.2%，76.1%，54.9%和93.3%，96.2%，78.1%，ROC曲线下面积分别为0.99，0.90， 0.69。结论：sCys C，uNGAL和uIL-18有助ICU早期预测和诊断AKI，并可能有助于AKI分期。

Value of acute renal injury associated biomarkers for patients in intensive care unit

Objective: To evaluate the early predictive and diagnostic signifi cance of the acute kidney injury (AKI) associated biomarkers for patients in the intensive care unit (ICU). Methods: From January to June, 2014, relevant clinical data of participants were collected upon admission to the intensive care unit (ICU) in Affiliated Hospital of Zunyi Medical College. Levels of serum cystatin C (sCys C), neutrophil gelatinase-associated lipocalin (sNGAL), urinaryneutrophil gelatinase-associated lipocalin (uNGAL), urinary kidney injury molecule-1 (uKIM- 1), interleukin-18 (uIL-18), and N-acetyl-beta-D-glucosaminidase (uNAG) were detected by enzyme linked immune sorbent assay (ELISA), and compared between AKI and non-AKI patients. Diagnostic significance of these biomarkers was evaluated by a receiver operating characteristic (ROC) curve and the area under the ROC curve. Results: A total of 176 patients were enrolled in this study. Among them, 71 patients were diagnosed as AKI, in which 57 patients hospitalized with AKI and 14 developed AKI after 24 h hospitalization. The renal replacement therapy ratio was increased with the progress of clinical stage for AKI. AKI mortality rate was 18.8% (46.5% of the total number of deaths). The levels of sCys C, sNGAL, uNGAL, and uIL-18 in AKI patients were increased compared with those in the non-AKI patients (P<0.05). With the progress of AKI, sCys C, and uNGAL levels were also elevated. In 14 patients who suffered from AKI 24 h after hospitalization, the average levels of sCys C, uNGAL, uIL-18, and uKIM-1 were significantly increased (P<0.05). Sensitivity and specificity of the uNGAL, sCys C, and uIL-18 in AKI diagnosis were 97.2%, 76.1%, 54.9% and 93.3 %, 96.2%, 78.1%, respectively. The areas under the ROC curve of uNGAL, sCys C, and uIL-18 were 0.99, 0.90, and 0.69, respectively. Conclusion: uNGAL, sCys C and uIL-18 can be used to predict and diagnose AKI, and to evaluate the AKI clinical stage.