尿胱抑素C和白细胞介素-18对危重新生儿急性肾损伤的预测价值  

Clinical value of urinary cystatin C and interleukin-18 in predicting acute kidney injury in critically ill neonates

作　　者：李梦霞[1] 严洁[2] 肖志辉[2] 李晓忠[1] 冯星[2] 李艳红[1] 

机构地区：[1]苏州大学附属儿童医院肾脏科,215003 [2]苏州大学附属儿童医院新生儿科,215003

出　　处：《中国新生儿科杂志》2013年第5期300-303,共4页Chinese Journal of Neonatology

基　　金：苏州市科技发展计划项目(SYS201137);江苏省教育厅面上项目(12KJB320006);江苏省自然科学基金资助项目(BK2012604)

摘　　要：目的探讨尿胱抑素C（Cys C）和尿白细胞介素-18（IL-18）对危重新生儿急性肾损伤（AKI）的早期预测价值。方法选择2010年9月至2011年2月生后6 h内入住本院新生儿重症监护病房的新生儿为研究对象进行前瞻性研究,根据入院1周内是否发生AKI,分为AKI组和非AKI组（对照组）。检测患儿入院当日尿Cys C、IL-18、微量白蛋白（MA）、α1微球蛋白（α1-MG）水平,并于入院24 h内进行新生儿急性生理学评分（SNAP）。以多因素Logistic回归分析评估在校正混杂因素后尿Cys C、IL-18与AKI的关系,用受试者工作特征（ROC）曲线及曲线下面积（AUC）评价尿Cys C、IL-18对新生儿AKI的预测价值。结果研究期间共纳入57例新生儿,11例（19.3%）在入院1周内发生AKI。AKI组出生体重、胎龄、Apagr评分均低于对照组,尿Cys C、IL-18、α1-MG、MA水平及SNAP评分均高于对照组,差异有统计学意义（P〈0.05）。Logistic回归分析显示,在校正胎龄、出生体重、尿MA、α1-MG水平及SNAP评分等因素后,尿Cys C、IL-18浓度与AKI显著相关。尿Cys C和IL-18预测新生儿AKI的AUC值分别为0.91（95%CI 0.82~0.99,P〈0.001）和0.74（95%CI 0.53~0.95,P=0.015）。结论尿Cys C、IL-18是新生儿AKI的独立预测指标,尿Cys C具有更好的早期预测价值。Objective To evaluate the predictive value of urinary cystatin C （CysC） and interleukin-18 （IL-18） in early diagnosis of acute kidney injury （AKI） in critically ill neonates. Methods Total of 57 neonates admitted to the intensive care unit during the first 6 hours of life from September 2010 to February 2011 were included in the current prospective study. Neonates were assigned into the AKI and non-AKI groups based on whether AKI was developed during the first week of life. Urine CysC, IL-18, Microalbumin, otl-microglobulin levels were measured on the day of admission. Scores for neonatal acute physiology （SNAP） based on 28 items collected over the first 24 hours of admission were calculated. Multivariate logistic regression analysis was used to determine whether urinary CysC and IL-18 levels were independent predictors of AKI. A receiver operating characteristic （ROC） curve was constructed and the area under the ROC curve （AUC） was calculated to assess the predictive strength of CysC and IL-18. Results Of the 57 neonates, 11 （ 19.3% ） developed AKI during the first week of admission. Comparing to the Non-AKI neonates, the gestational age, birth weight, Apgar scores in the neonates of the AKI group were significantly lower, but the urinary levels of CysC, IL-18, microalbuminuria, ctl-microglobulin and SNAP score were significantly higher （P 〈 0. 05 ）. Logistic regression study revealed that urinary CysC and IL-18 remained significantly associated with AK[ after being adjusted for gestational age, birth weight, and the SNAP score. Urinary CysC and IL-18 achieved theAUC of 0.91 （95% CI0.82-0.99,P 〈0.001） and 0.74 （95% CI0.53-0.95,P =0.015）, respectively, for predicting the development of AKI. Conclusions Urinary CysC and IL-18 are both independent predictors of AKI in critically ill neonates; urinary CysC has a better predictive value in early prediction of AKI.

关 键 词：危重新生儿 急性肾损伤 尿白细胞介素-18 尿胱抑素C 尿生物标志物 

分 类 号：R722.1[医药卫生—儿科]