尿肾损伤分子1及白细胞介素18水平检测在监测不同烧伤程度烧伤患者合并急性肾损伤中的临床意义

目的探讨尿肾损伤分子-1(KIM-1)及白细胞介素-18(IL-18)水平在不同程度烧伤患者合并急性肾损伤(AKI)早期诊断中的临床意义。方法将2013年4至9月我院烧伤整形中心95例住院烧伤患者,按烧伤面积、烧伤深度分为轻度烧伤组(37例)、中度烧伤组(30例)及重度烧伤组(28例),另选我院体检中心15名健康体检者作为对照组。分别留取血液及尿液,检测血Hb、WBC、BUN、Cr、ALT、AST、ALB水平;ELISA法检测尿KIM-1及IL-18水平,从而分析尿KIM-1及IL-18与烧伤程度及临床生化指标之间的相关关系。结果 (1)轻度烧伤组、中度烧伤组、重度烧伤组及健康对照组的尿KIM-1水平分别为(2.95±0.75)、(4.06±1.38)、(5.06±1.51)、(2.12±0.80)ng/ml,3组烧伤患者的尿KIM-1水平均明显高于健康对照组(P<0.05);三组烧伤患者及健康对照组的尿IL-18水平分别为(6.27±2.84)、(6.93±3.11)、(6.68±2.66)、(6.04±1.41)pg/ml,三组烧伤患者及对照组的尿IL-18水平比较差异无统计学意义。(2)重度烧伤合并AKI患者尿KIM-1[(6.18±1.62)ng/ml]及IL-18水平[(8.87±2.65)pg/ml]明显高于重度烧伤不合并AKI患者[(4.62±1.25)ng/ml,(5.80±2.16)pg/ml],差异均有统计学意义(P<0.05),且尿KIM-1及IL-18升高早于血肌酐升高。(3)尿KIM-1与血清BUN、Scr呈正相关,但与ALB呈负相关(r分别为0.454、0.345、-0.486,P均<0.05)。尿IL-18与血清Cr低度相关,但与血清BUN、ALB无相关性。结论尿KIM-1、IL-18可以作为预测不同程度烧伤患者合并AKI的早期敏感指标,为烧伤患者早期预防AKI提供一定的临床线索。

The significance of urine kidney injure molecule-1 and interleukin-18 in different degree burnt patients with acute kidney injure

Objective To investigate the value of urinary kidney injure molecule-1 （KIM-1） and interleukin-18 （IL-18） for early diagnosis of burnt patients in different degree with acute kidney injure（AKI）. Methods 95 burnt patients, according to the depth of burn area, were divided into three groups：mild burnt group （n=37）, moderate burnt group （n=30） and severe burnt group （n=28）, physical examination center of our hospital with 15 healthy volunteers as control group. By using enzyme linked immunosorbent assay （ELISA）, we detected levels of urinary KIM-1 and IL-18, analyzed correlation between it and burn severity and clinical indices of renal function. Results （1） The levels of urinary KIM-1 of mild burnt group, moderate burnt group, severe burnt group and healthy control group were （2.95±0.75）, （4.06±1.38）, （5.06±1.51）, （2.12±0.80）ng/ml, urinary KIM-1 levels in the 3 groups of burnt patients were significantly higher than those in the healthy control group （P＆lt;0.05）;urinary IL-18 levels in＆amp;nbsp;the 3 groups of burnt patients and healthy controls were （6.27±2.84）, （6.93±3.11）, （6.68±2.66）, （6.04±1.41）pg/ml, no statistical significance of urinary IL-18 levels in the 3 groups of burnt patients and control group comparison of difference （P＆gt;0.05）. （2） The levels of urinary KIM-1 [（6.18±1.62） ng/ml] and IL-18 [（8.87±2.65） pg/ml] of severe burnt complicated with acute kidney injury （AKI） group were significantly higher than those of group AKI [combined with severe burnt group were （4.62±1.25） ng/ml and （5.80±2.16） pg/ml], the differences were statistically significant （P＆lt;0.05）, and urinary KIM-1 and IL-18 increased earlier than the increase of serum creatinine. （3） Urinary KIM-1 and serum BUN, Scr, was positively correlated, however, it negatively correlated with ALB, in which Pearson correlation coefficients were respectively r=0.454, r=0.345, r=-0.486. Urinary IL-18 was positive with Scr, but had no correlation with BUN, Scr, ALB. Conclusion Urinary KIM-1, IL-18 could be regarded as the early sensitive indicator of burnt patients with acute kidney injury and it may become a potential index to prevent burnt patients to develop the AKI.