摘要
目的:研究肾损伤标志物金属蛋白酶组织抑制剂2(TIMP-2)联合胰岛素样生长因子结合蛋白7(IGFBP-7)对急性胰腺炎患者入院后发生急性肾损伤(AKI)的预测价值及最佳阈值。方法:这是一项多中心临床研究的二次分析,选择2021年4月至2022年4月全国11家急重症中心收治的急性胰腺炎患者临床资料。入院后收集患者血清标本,测量血清中生物标志物[TIMP-2]*[IGFBP-7]水平。使用受试者工作特征曲线下面积(AUC)评估该生物标志物对AKI的预测价值,并评估本研究中的最佳阈值。多因素Logistic回归模型评估发生AKI的独立危险因素。以阈值分组,比较高低标志物组人群间临床结局的差异。结果:本研究共纳入84例急性胰腺炎患者,其中19例(22.6%)患者发生AKI。[TIMP-2]*[IGFBP-7]预测AKI时AUC为0.83(最佳阈值为2.46),敏感度为88.9%,特异度为66.1%。多因素Logistic回归显示,急性生理学及慢性健康状况评估系统Ⅱ(APACHEⅡ)评分和[TIMP-2]*[IGFBP-7]水平都是AKI发生的独立危险因素。高标志物组(≥2.46)入院第3天发生器官功能衰竭的比例更高(P=0.019)且重症监护(ICU)住院时间更长(P=0.030)。结论:肾损伤标志物[TIMP-2]*[IGFBP-7]能早期预测急性胰腺炎入院后AKI的发生。高于阈值人群与重症监护病房住院时长增长和器官衰竭发生率增高相关。
Objective:Early detection of acute kidney injury in acute pancreatitis is of great significance for treatment and prognosis.The objective of this study was to investigate the predictive value and optimal cut-off value of tissue inhibitor of metalloproteinases-2(TIMP-2)*insulin-like growth factor-binding protein 7(IGFBP-7),for the occurrence of acute kidney injury(AKI)after admission in patients with acute pancreatitis(AP).Methodology:The study was a post hoc analysis of a multicenter clinical trial.The clinical data of AP patients who met the eligibility criteria and were admitted to 11 emergency and critical care centers across the country from April 2021 to April 2022 were selected.After admission,blood samples of the patients were collected to measure the levels of[TIMP-2]*[IGFBP-7].The area under curve(AUC)was used to evaluate the predictive value of this biomarker for AKI,and the optimal cut-off value in this study was evaluated.Multivariate logistic regression model was used to evaluate the independent risk factors for AKI.The differences in clinical outcomes between the high and low marker groups were compared,which were distinguished by the optimal cut-off value.Results:A total of 84 patients with AP were included in this study,among whom 19 patients(22.6%)developed AKI.The AUC predicted by[TIMP-2]*[IGFBP-7]for AKI was 0.83(the optimal cut-off value was 2.46),the sensitivity was 88.9%,and the specificity was 66.1%.Multivariate logistic regression showed that the Acute Physiology and Chronic Health Evaluation SystemⅡ(APACHEⅡ)score and the levels of[TIMP-2]*[IGFBP-7]were associated with AKI.The proportion of organ failure occurring on the third day of admission was higher in the high-marker group(≥2.46)(P=0.019)and the length of intensive care unit(ICU)stay was longer(P=0.030).Conclusion:Renal injury biomarker([TIMP-2]*[IGFBP-7])can predict the occurrence of AKI after admission in AP patients.The population above the cut-off value was associated with an increased length of stay in the ICU and a higher incidence of organ failure.In the future,this biomarker may help to identify high-risk patients with AKI in AP at an early stage,prompt clinical attention,and enable early intervention,ultimately improving prognosis.
作者
黄铭凤
叶博
皋林
柯路
刘玉秀
童智慧
李维勤
HUANG Mingfeng;YE Bo;GAO Lin;KE Lu;LIU Yuxiu;TONG Zhihui;LI Weiqin(Department of Critical Care Medicine,Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210016,China)
出处
《肾脏病与透析肾移植杂志》
2025年第4期309-314,共6页
Chinese Journal of Nephrology,Dialysis & Transplantation
关键词
急性胰腺炎
急性肾损伤
标志物
预测价值
acute pancreatitis
acute kidney injury
biomarker
predictive value
