呼吸衰竭并急性肾损伤患者白介素18、中性粒细胞明胶酶相关脂质运载蛋白和胱抑素C水平变化及其临床意义  

Change and Clinical Significance of IL-18,NGAL and Cystatin C of Respiratory Failure Patients Complicated With Acute Kidney Injury

作　　者：燕存子[1] 张莹[1] 孙虎[2] 孙峰[1] YAN Cun-zi ZHANG Ying SUN Hu SUN Feng(the Second Department of Respiratory Medicine, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China)

机构地区：[1]新疆医科大学第一附属医院呼吸二科 [2]新疆医科大学第一附属医院呼吸重症监护室

出　　处：《实用心脑肺血管病杂志》2016年第6期46-50,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：新疆维吾尔自治区自然科学基金项目(2014211C023)

摘　　要：目的观察呼吸衰竭并急性肾损伤(AKI)患者白介素18(IL-18)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、胱抑素C(Cys-C)水平变化,并探讨其临床意义。方法选取2015年2—9月新疆医科大学第一附属医院收治的呼吸衰竭患者147例,其中单纯呼吸衰竭患者86例(A组)、呼吸衰竭并AKI患者61例(B组)。比较两组及不同分期AKI患者IL-18水平、NGAL水平、Cys-C水平、血肌酐(Scr)水平、尿素氮(BUN)水平、估算肾小球滤过率(e GFR)及尿蛋白量。结果 B组患者IL-18水平、NGAL水平、Cys-C水平、Scr水平、BUN水平、尿蛋白量高于A组,e GFR低于A组(P<0.05)。AKI 3期、AKI 2期患者IL-18水平、NGAL水平、Cys-C水平、Scr水平、BUN水平、尿蛋白量高于AKI 1期患者,e GFR低于AKI 1期患者(P<0.05);AKI 3期患者IL-18水平、NGAL水平、Cys-C水平、Scr水平、BUN水平、尿蛋白量高于AKI 2期患者,e GFR低于AKI 2期患者(P<0.05)。IL-18预测呼吸衰竭患者AKI的曲线下面积为0.850〔95%CI(0.514,0.927)〕,当IL-18为95.3μg/kg时其灵敏度为83.02%,特异度为88.46%,诊断指数为1.772;NGAL预测呼吸衰竭患者AKI的曲线下面积为0.835〔95%CI(0.446,0.896)〕,当NGAL为51.3μg/kg时其灵敏度为80.14%,特异度为84.77%,诊断指数为1.649;Cys-C预测呼吸衰竭患者AKI的曲线下面积为0.900〔95%CI(0.583,0.951)〕,当Cys-C为1.8 mg/L时其灵敏度为88.92%,特异度为91.04%,诊断指数为11.800。结论呼吸衰竭并AKI患者IL-18、NGAL、Cys-C水平明显升高,其可预测AKI的发生,进而指导临床诊断及治疗,改善患者预后。Objective To observe the change of IL-18,NGAL and cystatin C of respiratory failure patients complicated with acute kidney injury,to explore the clinical significance. Methods A total of 147 patients with respiratory failure were selected in the First Affiliated Hospital of Xinjiang Medical University from February to September in 2015,and they were divided into A group（did not complicated with acute kidney injury,n = 86）and B group（complicated with acute kidney injury,n = 61） according to the complication of acute kidney injury. IL-18,NGAL,cystatin C,Scr,BUN,eGFR and urinary protein excretion were compared between the two groups and in patients with different stages of actcte kidney injury.＆nbsp;Results IL-18,NGAL,cystatin C,Scr,BUN and urinary protein excretion of B group were statistically significantly higher than those of A group,while eGFR of B group was statistically significantly lower than that of A group（ P ﹤ 0. 05）. IL-18, NGAL,cystatin C,Scr,BUN and urinary protein excretion of respiratory failure patients with 3 - stage,2 - stage acute kidney injury were statistically significantly higher than those of respiratory failure patients with 1 - stage acute kidney injury,while eGFR of respiratory failure patients with 3 - stage,2 - stage acute kidney injury was statistically significantly lower than that of respiratory failure patients with 1 - stage acute kidney injury,respectively（P ﹤ 0. 05）;IL-18,NGAL,cystatin C,Scr,BUN and urinary protein excretion of respiratory failure patients with 3 - stage acute kidney injury were statistically significantly higher than those of respiratory failure patients with 2 - stage acute kidney injury,while eGFR of respiratory failure patients with 3 -stage acute kidney injury was statistically significantly lower than that of respiratory failure patients with 2 - stage acute kidney injury（P ﹤ 0. 05）. The AUC of IL-18 in predicting acute kidney injury was 0. 850〔95% CI（0. 514,0. 927）〕,when IL-8 was 95. 3 μg/ kg,the sensitivity was 83. 02

关 键 词：呼吸功能不全 急性肾损伤 白细胞介素 18 中性粒细胞明胶酶相关脂质运载蛋白 胱抑素 C 诊断 

分 类 号：R563.8[医药卫生—呼吸系统]