尿NAG联合血清CysC预测重症患者急性肾损伤诊断和预后的临床价值  

Clinical value of urine NAG combined with serum CysC in predicting diagosis and prognosis of acute kidney injury in critically ill patients

作　　者：池锐彬[1,2,3] 邓宇珺[2] 袁婕[2] 王琳[2] 吕波[2] 龙怡[2] 孙诚[2] 陈纯波[2] 

机构地区：[1]南方医科大学,广州510515 [2]广东省人民医院,广东省医学科学院重症医学科,广州510080 [3]南方医科大学附属小榄医院重症医学科,广东省中山528415

出　　处：《中华急诊医学杂志》2016年第2期194-199,共6页Chinese Journal of Emergency Medicine

摘　　要：目的 探讨尿N-乙酰-β-D-氨基葡萄糖苷酶（uNAG）、血清胱抑素C（sCysC）在成人重症患者中预测急性肾损伤（AKI）诊断和预后的临床价值。方法 前瞻性入选2014年10月至2015年1月入住广东省人民重症医学科（ICU）的重症患者198例。以KDIGO标准为诊断标准，将患者分为非AKI组和AKI组（包括轻症AKI组和重症AKI组），检测并比较各组患者uNAG、sCysC水平。运用受试者工作特征（ROC）曲线及曲线下面积（AUC）评价2种生物标志物单独及联合检测对AKI的诊断和预后的预测价值。结果 （1） 198例重型患者中有51例发生AKI，AKI发生率为25.8%。（2）AKI组患者uNAG、sCysC水平明显高于非AKI组，差异有统计学意义（均P〈0.001）。（3） 19例患者发展为重症AKI（9.6%），重症AKI组uNAG、sCysC水平明显高于非AKI组和轻症AKI组，差异有统计学意义（分别P〈0.001和P〈0.01）。（3）uNAG、sCysC单独及联合预测AKI的AUC分别为O.743、0.716、0.781，预测重症AKI的AUC分别为O.893、0.891、0.929，联合标志物预测AKI及重症AKI的AUC均高于单独标志物。（4）整个研究队列中，住院死亡率为7.1%，AKI组死亡率明显高于非AKI组（P〈0.001）。uNAG联合sCysC预测AKI患者住院死亡的AUC为O.947，高于单一标志物（uNAG为0.905、sCysC为0.861）。结论 uNAG和sCysC是预测重症患者发生AKI及预后的敏感指标，两者联合检测能够更好地预测重症患者发生AKI和住院死亡率。Objective To explore the clinical value of urine N-Acetyl-β-D-glucosaminidase （uNAG） combined with serum cystatin C （sCysC） in predicting diagosis and prognosis of acute kidney injury （AKI） in adult critically ill patients. Methods In this study, 198 adult critically ill patients admitted to the adult mixed ICU of Guangdong Generel Hospital were prospectively enrolled from October 2014 to January 2015. According to the Kidney Disease Improving Global Outcomes （KDIGO） criterion, the patients were divided into non-AKI group and AKI group （including mild AKI and severe AKI ）. These biomarkers＇ capability of detecting AKI and its prognosis were evaluated by using the receiver operating characteristic （ROC） curve and the area under curve （AUC）. Results There were 51 AKI patients （25.8%）. The levels of uNAG and sCysC were significantly higher in AKI than in non-AKI （P 〈 0. 001 ）. In total, there were 9 patients （9.6%） developed into severe AKI. The levels of uNAG and sCysC were significantly higher in severe AKI than those in non-AKI and mild AKI （ P 〈 0. 01 ） . Combination of uNAG and sCysC predicted AKI and severe AKI after ICU admission with a higher AUC value （0. 781 ＆ 0. 929 ） than each biomarker alone. The overall In-hospital mortality was 7. 1% in this cohort of patients, and it was strikingly higher in AKI group than that in non AKI group （P 〈0.01 ）. The uNAG and sCysC separately predicted in-hospital mortality with AUC value of 0. 905 and 0. 861, while the combination of uNAG and sCysC improved the in-hospital mortality prediction （ AUC 0. 947）. Conclusions The uNAG and sCysC are sensitive for predicting diagnosis and prognosis of AKI in adult critically ill patients. Combination of biomarkers improves the predictive performance of AKI detection and in-hospital mortality.

关 键 词：生物标志物 重症患者 急性肾损伤 诊断与预后 

分 类 号：R692[医药卫生—泌尿科学]