重症监护病房患儿并发急性肾损伤的病因分析及早期诊断指标的研究  

Novel urinary biomarkers and etiology analysis on patients with acute kidney injury in pediatric intensive care unit

作　　者：潘国权[1] 梁亚峰[1] 林蓓蓓[1] 唐震海[1] 卢露[1] 陈旭[1] 陈敏广[1] 

机构地区：[1]温州医科大学附属第二医院育英儿童医院儿童ICU,浙江温州325027

出　　处：《中华危重症医学杂志（电子版）》2015年第6期351-355,共5页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：温州市科技局计划项目(Y20100179);浙江省中医药科学研究基金项目(2011ZA076)

摘　　要：目的探讨儿童重症监护室(PICU)患儿并发急性肾损伤的病因分布及尿液中中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、白细胞介素18(IL-18)和肾损伤分子1(KIM-1)在儿童急性肾损伤(AKI)早期诊断中的意义。方法选取100例2013年1月至2014年6月在PICU住院治疗的患儿,并按照AKI诊断标准分为AKI组及非AKI组,每组50例,并选择50例健康儿童作为对照组。分析AKI组患儿病因分布特点,连续检测诊断前3 d其尿液中NGAL、IL-18、KIM-1含量及血肌酐水平变化。采用Pearson相关分析NGAL、IL-18、KIM-1含量与血清肌酐的相关性。结果 50例AKI组患儿中,肾前性病因最常见,占所有患儿的78%(39/50),其中以感染性相关疾病最多见(28/50,56%)。诊断前2 d AKI组患儿尿NGAL水平较AKI诊断前3 d显著升高[(1.87±0.57)mg/L vs.(1.25±0.42)mg/L,P<0.05],而尿IL-18、KIM-1和血肌酐水平在诊断前2 d与3 d比较差异均无统计学意义(P均>0.05)。AKI组患儿诊断前1 d与诊断当天尿NGAL、IL-18、KIM-1及血肌酐的水平较诊断前3 d及诊断前2 d均显著升高(P均<0.05)。非AKI组和对照组患儿诊断前各时间段尿NGAL、IL-18、KIM-1和血肌酐水平比较差异均无统计学意义(P均>0.05)。且尿NGAL、IL-18和KIM-1的水平与血肌酐水平呈正相关(r=0.607、0.428、0.477,P均<0.05)。结论在PICU中,感染性相关疾病等肾前性病因引起的AKI较常见,且尿NGAL、IL-18和KIM-1可作为早期儿童急性肾损伤诊断指标。Objective To analyze the etiology distribution characteristics and urine neutrophil gelatinase associated lipocalin（NGAL）, interleukin-18（IL-18） and kidney injury molecule-1（KIM-1） on the early stage of patients with acute kidney injury（AKI） in pediatric intensive care unit（PICU）. Methods Totally 100 patients from January 2013 to June 2014 in the 2nd Affiliated Hospital Yuying Children＇s Hospital of Wenzhou Medical University were divided into the AKI group and non-AKI group according to the diagnostic criteria of AKI, 50 patients in each group, and 50 cases of healthy children were chosen as the control group. The etiology distribution characteristics of the patients in the AKI group were analyzed. The levels of NGAL, IL-18, KIM-1 and serum creatinine were detected and compared on 1, 2, 3 d before and on the day of AKI diagnosis and among the three groups. The Pearson correlation analysis was used to analyze the correlation of NGAL, IL-18, KIM-1 and serum creatinine. Results The major cause of AKI was pre-renal AKI（78%, 39 / 50）, and infective diseases was major cause of pre-renal AKI（56%, 28 / 50）. In the AKI group, the levels of NGAL on 2 d before AKI diagnosis were higher than those on 3 d before AKI diagnosis [（1.87 ± 0.57） mg / L vs.（1.25 ±0.42） mg / L,P〈0.05], but the levels of IL-18, KIM-1 and serum creatinine showed no significant differences between the 2, 3 d before the AKI diagnosis（allP〈0.05）. The levels of NGAL, IL-18, KIM-1 and serum creatinine on 1 d before and on the day of AKI diagnosis increased markedly as compared with those on 2, 3 d before AKI diagnosis in the AKI group（allP〈0.05）. However, the levels of NGAL, IL-18, KIM-1 and serum creatinine in the non-AKI group and control group all showed no significant differences among all the time before and on the day of AKI diagnosis（allP〈0.05）. The urinary NGAL, IL-18 and KIM-1 were positively correlated with serum creatinine in the AKI group（r = 0.607, 0.428, 0.477, allP〈0.05）.Conc

关 键 词：重症监护病房 儿科 急性肾损伤 中性粒细胞明胶酶相关脂质运载蛋白 白细胞介素18 肾损伤分子1 

分 类 号：R726.9[医药卫生—儿科]