肾损伤分子-1对于脓毒症急性肾损伤的早期诊断作用  

Kidney injury molecule - 1 testing for early diagnosis in patients with septic acute kidney injury

作　　者：孟广蕊 李春盛[2] 

机构地区：[1]北京朝阳区第二医院急诊科,100026 [2]首都医科大学附属北京朝阳医院急诊科,100020

出　　处：《中国急救医学》2011年第12期1106-1110,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的检测肾损伤分子-1（kidneyinjurymolecule-1，KIM-1）可对脓毒症急性。肾损伤（acutekidnoyinjury，AKI）患者具有早期诊断作用。方法选取自2007—10～2008—10在首都医科大学附属北京朝阳医院急诊抢救室收治脓毒症患者176例，分别检测KIM-1，血、尿β2-微球蛋白（beta2-mieroglobulin，β2-MG），尿微量白蛋白浓度，根据是否出现急性肾损伤分组，研究KIM-1浓度升高早期诊断急性肾损伤的价值。结果随访28d，51例患者出现AKI，AKI发病率29％；AKI组KIM-1，血、尿β2-MG浓度均高于非AKI组（P〈0．05）；KIM-1与血β2-MG，尿β2-MG呈正相关（r=0．61，P〈0．01；r=0．445，P〈0．01），KIM-1〉19．83pg／mL是预测AKI的独立危险因素，（OR1．416，95％CI1．155—1．737）。ROC曲线下面积：KIM-1是0．879，界值为19．83ps／mL（灵敏度82．0％，特异度84．5％）。结论KIM-1在尿中早期出现，具有较高的敏感性及特异性，可以早期诊断脓毒症相关急性肾损伤。Objective To study whether kidney injury molecule - 1 （ KIM - 1 ） has clinical significance in early diagnosis and forecasting acute kidney injury （AKI） in patients with sepsis. Methods From Oct. 2007 to Oct. 2008, total of 176 patients with sepsis were collected at the emergency department of Beijing Chaoyang hospital attached with the capital medical university. Control group consisted of 50 healthy people. The levels of Urinary KIM - 1, urinary and serum beta 2 - microglobulin （ 132 - MG） and concentration of microalbumin in urine were detected respectively. The incidence rate of acute kidney injury （AKI） was followed up during the early 28 days. Results 51 patients developed AKI, incidence rate of AKI is 29% during the early 28 days. The levels of KIM - 1, serum and urinary 132 - MG with AKI is significently higher than it in control group （ P 〈 0.05 ）. A significant direct correlation was found between urinary KIM - 1 level and both serum β2 - MG, urinary β2 - MG （ r = 0.61, P 〈 0. 01 ; r = 0. 445, P 〈 0.01 ）. Logistic regression analyses and the significant risk factors showed high Urinary KIM - I （OR 1. 416,95% CI 1. 155 -1. 737）was the independent determinants for AKI. The area under the ROC was 0. 879 for predicting AKI, indicating good model discrimination. The optimal KIM - 1 cut point for predicting incidence rate of AKI was 19.83 pg/dL. Conclusion KIM - 1 could be a biomarker in early diagnosis and a predictor to patients with sepsis related with AKI.

关 键 词：肾损伤分子-1(KIM—1) Β2-微球蛋白 脓毒症 急性肾损伤(AKI) 

分 类 号：R692[医药卫生—泌尿科学]