尿中肝型脂肪酸结合蛋白及白细胞介素18对急性肾损伤预后的预测作用  

Prediction of Urinary Interleukin-18 and Urinary Liver-type Fatty Acid Binding Protein in the Prognosis of Patients with Acute Kidney Injury

作　　者：郑新明[1] 高月花[2] 那宇[1] 

机构地区：[1]安徽医科大学解放军306临床学院,北京100101 [2]解放军306医院,北京100101

出　　处：《中国中西医结合肾病杂志》2016年第9期777-780,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金："十二五"国家科技支撑计划项目(No.2011BAI10B08);"十二五"全军重大项目(No.AWS11J013);"十二五"全军重点项目(No.BWS11J051)

摘　　要：目的:探讨在行肾脏替代治疗(renal replacement therapy,RRT)的急性肾损伤(acute kidney injury,AKI)患者中,尿肝型脂肪酸结合蛋白(liver-type fatty acid binding proteins,L-FABP)及白细胞介素18(interleukin-18,IL-18)以及联合急性生理和慢性健康评分Ⅱ(APACHEⅡ评分)对患者预后的预测作用。方法:前瞻性收集需行RRT的AKI患者共48例,记录相关临床资料,留取尿液标本,酶联免疫吸附法(ELISA)检测尿L-FABP及尿IL-18水平。随访90 d,记录预后情况。运用受试者工作曲线(receiver operating characteristic,ROC曲线)的曲线下面积(area under curve,AUC)及Logistic回归分析的方法分析尿L-FABP、尿IL-18、APACHEⅡ评分及其联合后对患者预后的预测价值。结果:(1)入选的48例患者中,28 d内死亡20例(41.67%),28 d内依赖透析23例(47.9%);90 d内死亡28例(58.3%),90 d内依赖透析20例(41.67%)。(2)尿IL-18预测患者28 d及90 d内死亡的AUC分别为0.719和0.844;预测患者28 d及90 d内依赖透析的AUC分别为0.706和0.645。(3)尿L-FABP预测患者28 d及90 d内死亡的AUC分别为0.77和0.734;预测患者28 d及90 d依赖透析的AUC分别为0.719和0.674。(4)联合尿IL-18和尿L-FABP,预测患者28 d及90 d内死亡的AUC分别提高至0.78和0.866;预测患者28 d及90 d内依赖透析的AUC分别提高至0.741和0.684。(5)将尿IL-18、尿L-FABP与APACHEⅡ评分联合,预测患者28 d及90 d内死亡的AUC分别为0.804和0.895;预测28 d及90 d内依赖透析的AUC分别为0.802和0.746。结论:尿L-FABP和尿IL-18可单独预测AKI患者预后,两者联合后预测能力提高,再与临床指标APACHEⅡ评分联合,预测能力再次提高。Objective：To assess the values of urinary biomarkers, Interleukin - 18 （ IL - 18 ） and Liver - type Fatty Acid Binding Protein （ L - FABP）, combining Acute Physiology and Chronic Health Evaluation Ⅱ （ APACHE Ⅱ ） were used to predict the Clinical Prognosis of Patients with Acute Kidney Injury （AKI） who required Renal Replacement Therapy（RRT）. Methods：A total of 48 hospitalized patients were enrolled at the time of nephrologists consultation. The clinical message of the enrolled patients was recorded and the urine samples were collected. Enzyme -linked immune sorbent assay （ELISA） was carried out to detect the concentration of urinary IL - 18 and L - FABP. Patients were followed - up to evaluate the prognosis at 90 days after RRT. Area under curve （AUC） of receiver operating characteristic （ROC） curve and Logistic regression were used to evaluate the value of these biomarkers in predicting prognosis. Results： （ 1 ） Of the 48 hospitalized AKI patients, 20 patients （41.67%） died and 23 patients （47.9%） were dependent on dialysis within 28 days after RRT. 28 patients （58.3%） died and 20 patients （41.67%） were dependent on dialysis within 90 days. （2）The AUC of urinary IL - 18 were 0.719 and 0.844 respectively in predicting 28 and 90 days mortality of the patients and were 0. 706 and 0. 645 respectively in predicting 28 and 90 days dialysis dependence. （3） The AUC of urinary L - FABP were 0.77 and 0.734 respectively in predicting 28 and 90 days mortality of the patients and were 0.719 and 0.674 respectively in predicting 28 and 90 days dialysis dependence. （4） When urinary IL - 18 and urinary L - FABP were united, the AUC could rise to 0.77 and 0.734 respectively in predicting 28 and 90 days mortality of the patients, while the AUC could rise to 0.741 and 0. 684 re- spectively in predicting 28 and 90 days dialysis dependence. （5） When urinary IL - 18, urinary L - FABP and APACHE Ⅱ were united, the AUC could rise to 0. 804 and 0.895 respecti

关 键 词：急性肾损伤 预后 尿IL-18 尿L-FABP 

分 类 号：R692[医药卫生—泌尿科学]