摘要
目的 观察肾损伤分子-1（kidney injury molecule 1,KIM-1）与Clara细胞分泌蛋白（Clara cell secretionprotein,CCSP/CC16）在急性肾损伤（Acute Kidney Injury,AKI）合并急性肺损伤（Acute Lung Injury,ALI）患者体内的变化,探讨其在急性肾/肺损伤临床诊断中的意义.方法 入选本院确诊为AKI的患者纳入AKI组（25例）,确诊为ALI的患者纳入ALI组（15例）,确诊为AKI合并ALI的患者纳入AKI＋ALI组（25例）,与之年龄、性别、民族相匹配的非吸烟健康志愿者作为正常对照组（23例）,采用酶联免疫吸附法（enzyme-linked immunosorbent assay,ELISA）检测尿液KIM-1、尿液CC16和血浆KIM-1、血浆CC16的水平,用比色法检测尿N-乙酰-β-D-氨基葡萄糖苷酶（N-acetyl-beta-D-glucosaminidase,NAG）,整理四组所有研究资料利用统计学方法进行综合分析.结果 与正常非吸烟对照组相比,AKI组的尿NAG酶、尿KIM-1、血浆KIM-1和血浆CC16水平均显著升高,差异有统计学意义（P＜0.05）;ALI组的尿CC16和血浆CC16水平均显著升高,差异有统计学意义（P ＜0.05）;AKI＋ALI组的尿NAG酶、尿KIM-1、血浆KIM-1、尿CC16和血浆CC16水平均显著升高,差异有统计学意义（P＜0.05）.直线相关分析显示：AKI患者的尿KIM-1水平与尿NAG呈显著正相关关系（r=0.493,P＜0.01）,血浆KIM-1水平与尿NAG无直线相关关系（r =0.276,P＞0.05）.ALI患者的尿CC16、血浆CC16与氧合指数均呈显著负相关关系（r=0.460,P＜0.01;r=0.468,P＜0.01）.AKI合并ALI患者的尿KIM-1、血浆KIM-1与尿CC16、血浆CC16均呈显著正相关关系（P＜0.05）.ROC曲线分析提示：在AKI诊断中,尿KIM-1曲线下面积为0.781（95％ CI：0.688 ～0.875,P＜0.01）;血浆KIM-1曲线下面积为0.988（95％ CI：0.000～1.000,P＜0.01）;尿NAG酶曲线下面积为0.798 （95％CI：0.708～0.888,P＜0.01）.在ALI诊断中,尿CC16曲线下面积为1.000（95％ CI：1.000 ～1.000,P＜0.01）;血浆CC16曲线面积为0.849（95％ CI：0.764～0.935,P＜0.01）.结论 AKI时尿NAG、尿KIM-1、血浆KIM-1均明显升高,进一步证实这些指标可作为诊断AKI早期生物学标志物.ALI时尿CC16、血浆CC16水平显著升高,同时具有高敏感性,是诊断ALI的良好实验室指标.急性肾/肺损伤患者体内尿、血浆KIM-1与CC16水平明显升高,二者具有良好的相关性,对诊断急性肾/肺损伤并判断预后具有重要的价值与临床意义.
Objectives To investigate the change of kidney injury molecule 1 （KIM-1） and Clara cell secretion protein（CCSWCC16） in the patients with acute kidney injury（AKI） and acute lung injury（ALI）,and study the significance of acute kidney/lung injury.Methods A study was conducted in 25 pure AKI patients,15 pure ALI patients,25 AKI and ALI patients,and 23 non-smoking controls （age,race,and gender-matched）.ELISA method to detect urinary KIM-1 、plasma KIM-1 、urinary CC16 and plasma CC16; colorimetric method to detect urinary N-acetyl-beta-D-glucosaminidase（NAG）.Results Campa^d with non-smoking control group,the urinary NAG 、urinary KIM-1 、plasma KIM-1 and plasma CC16 values were significantly increased in AKI group（P ＜0.05） ; the urinary CC16 and plasma CC16 values were significantly increased in ALI group （P ＜0.05） ;the urinary NAG、urinary KIM-1 、plasma KIM-1 、urinary CC16 and plasma CC16 values were significantly increased in AKI and ALI group（P ＜ 0.05）.Correlation analysis showed：In AKI patients,urinary KIM-1 was positive correlated with urinary NAG （r =0.493,P ＜0.01）,while the plasma KIM-1 was no correlated with urinary NAG.In ALI patients,urinary CC16 was negative correlated with oxygenation index,the same as plasma CC16（P ＜0.01）.In AKI and ALI group,urinary KIM-1 、plasma KIM-1were positive associated with urinary CC16 and plasma CC16 respectively （P ＜ 0.05）.3.Receiver operator characteristic curve （ROC） analysis showed：In AKI,the area under the curve （AUC） of urinary KIM-1 was 0.781 （95 ％ CI 0.688 ～ 0.875,P ＜ 0.01） ; plasma KIM-1 was 0.988 （95％ CI 0.000 ～ 1.000,P ＜ 0.01） ; urinary NAG was 0.798 （95％ CI 0.708 ～ 0.888,P ＜ 0.01）.In ALI,the AUC of urinary CC 16 was 1.000 （95 ％ CI 1.000 ～ 1.000,P ＜ 0.01） ; plasma CC 16 was 0.849 （95 ％ CI 0.764 ～ 0.935,P ＜ 0.01）.Conclusions Urinary NAG,urinary KIM-1 and plasma KIM-1 were obviously increased in AKI,showed that these indicators can be used to early diagnose AKI.Urinary CC16 and plasma CC16 were significantly elevated in ALI,and with high sensitivity,suggested that CC16 can serve as a good biomarker for ALI.Urinary and plasma KIM-1 and CC16 were significantly increased in acute kidney/lung injury and with good correlation,showed that KIM-1,CC16 have clinical significance for diagnosis and prognosis of acute kidney/lung injury.
出处
《国际泌尿系统杂志》
2014年第1期1-8,共8页
International Journal of Urology and Nephrology
关键词
肾
肺
蛋白质类
Kidney
Lung
Proteins
