摘要
目的探讨生物学标志物在预测住院期间急性肾损伤（AKI）患者预后中的价值。方法前瞻性选取请肾脏科医生会诊的AKI患者103例为对象。在会诊确诊AKI时留取患者的血和尿标本。ELISA法检测尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、白细胞介素（IL）6和IL-18；比色法检测尿N-乙酰-β-D氨基葡萄糖苷酶（NAG）水平。微粒子增强比浊法检测血半胱氨酸蛋白酶抑制剂C（CysC）；同时记录患者的基础Scr（bScr）、会诊时的Scr（cScr）和最高Scr（pScr）。随访会诊后28d时的患者预后和肾脏预后。比较存活和死亡患者之间以及肾脏存活和丢失患者之间各标志物的水平，并运用ROC曲线下面积（AUC）评价各标志物预测患者死亡、肾脏丢失以及需行肾替代治疗（RRT）的敏感性与特异性。AKI定义为会诊前48h内Scr较基础值升高≥50％。结果（1）103例住院AKI患者，平均年龄（54．28±19．05）岁，男女比例1.86：1。（2）会诊后28d患者病死率为25．2％。死亡和存活患者的bScr、cScr和pScr均相似，但会诊时的尿NGAL水平在死亡患者中显著高于存活患者【147．00（31．59—221．87）mg／L比22．43（6．48—89．77）mg／L，P=0．0011，而血CysC、尿IL-6、尿IL-18和尿NAG在两组间差异均无统计学意义。多因素Logistic回归分析显示尿NGAL是预测患者死亡的独立危险因素（OR=1．011，95％CI1．004～1．018，P=0．001），尿NGAL预测患者死亡的AUC为0．723。（3）会诊后28d患者的肾脏丢失率为20．4％。肾脏存活和丢失患者的bScr、cScr和pScr值均相似，但会诊时肾脏丢失患者的尿NAG、尿IL-6、尿NGAL和尿IL-18水平均显著高于肾脏存活患者。多因素Logisitc回归分析显示尿IL-6是预测肾脏丢失的独立危险因素（OR=1．056，95％CI1．009～1．105，P=0．018），其AUC为0．705。（4）会诊后28d患者行RRT治疗率为46．6％，行RRT时间距离会诊的中位时间为2．17（0，3）d。行RRT患者的cScr、pScr以及会诊时的血CysC、尿IL-6和尿NGAL水平均高于未行RRT组（均P〈0．01）。多因素分析显示尿NGAL是预测行RRT的独立危险因素（OR=1．012，95％CI1．005～1．019，P〈0．01），其AUC为0．775。结论肾科医生会诊时的尿NGAL水平可以较好地预测住院AKI患者的预后，包括患者预后和RRT治疗。会诊时的尿IL-6可能有助于预测住院AKI患者肾脏的预后。然而，这观点还需要进行大样本的研究来进一步证实。
Objective To investigate the value of biomarker levels at the time of nephrologists consultation in predicting the prognosis of acute kidney injury （AKI） patients. Methods A total of 103 hospitalized patients with AKI were enrolled at the time of nephrologists consultation. Blood and urine samples were collected when patients were diagnosed as AKI. ELISA was used to detect the concentration of urinary biomarkers including neutrophil gelatinase-associated lipocalin （NGAL）, IL-6 and IL-18. Colorimetric method was used to measure urinary N- acetyl-13- D- glucosaminidase （NAG）. Turbidimetry and enzymic method were applied to examine the concentration of serum cystatin C （Cys C）, baseline Scr （bScr）, Scr at consultation （cScr） and the peak of Scr （pScr） respectively. Patients were followed- up to evaluate the prognosis at 28 days after consultation, including patient survival and kidney survival. The levels of biomarkers between different groups, including patient survival or death, kidney recovery or lose and renal replacement therapy （RRT） or not, were compared. Area under curve （AUC） of receiver operating characteristic （ROC） curve of these biomarkers were used to evaluate the sensitivity and specificity in predicting prognosis. AKI was defined as the Scr at the time of consultation increased more than 50% of baseline Scr within 48 hours. Results （1）Mean age of 103 hospitalized AKI patients was （54.28±19.05） years old and ratio of male to female was 1.86 to 1. （2） Patient mortality was 25.2% at 28 days after consultation. The bScr, cScr and pScr were similar between survival and death group, while the concentration of urinary NGAL in death group was significantly higher than that of survival group [147.00（31.59, 221.87） mg/L vs 22.43（6.48, 89.77） mg/L, P = 0.001]. The serum Cys C, urinary IL-6 and NAG were similar between survival and death group （P 〉 0.05）. Logistic regression analysis showed urinary NGAL was an independent risk factor of patient survival （OR= 1.011, 95%CI 1.004-1.018, P= 0.001） with AUC of 0.723. （3）Kidney lose rate was 20.4% at 28 days after consultation. The bScr, cScr and pScr were similar between patients with kidney survival and lose. The levels of urinary NAG, IL-6, NGAL and IL-18 were significantly higher in patients with kidney lose than those of kidney survival. Logistic regression analysis showed urinary IL-6 was an independent risk factor of renal survival （OR = 1.056, 95% CI 1.009-1.105, P = 0.018） with AUC of 0.705. （4）The median time from consultation to RRT was 2.17 （0-3） days. The concentrations of cScr, pScr, serum Cys C, urinary IL-6 and NGAL were significantly higher in RRT patients than thosein non- RRT patients （P 〈 0.05）. Logistic regression analysis showed urinary NGAL was an independent risk factor of RRT （OR = 1.012, 95% CI 1.005 - 1.019, P 〈 0.01） with AUC of 0.775. Conclusions Urinary NGAL can predict the prognosis of AKI patients, including patient prognosis and RRT. Urinary IL-6 may predict kidney prognosis in hospitalized patients with AKI. More study with large samples should be done for further estimation of the results.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2013年第3期163-168,共6页
Chinese Journal of Nephrology
基金
基金项目：国家自然科学基金（81170687）
上海市医学发展基金重点研究课题（2003ZD001）
关键词
肾功能不全
急性
预后
生物学标志物
肾替代治疗
Kidney insufficiency, acute
Prognosis
Biomarkers
Renal replacement therapy
