尿肾损伤分子-1及血清半胱氨酸蛋白酶抑制剂C对急诊危重症患者急性肾损伤的预测价值  

Assessment of urinary KIM - 1 and serum Cystain C in acute kidney injury of critical patients inemergency department

作　　者：王军宇[1] 张达[1] 梅雪[1] 

机构地区：[1]首都医科大学附属北京朝阳医院急诊科,北京100020

出　　处：《中国急救医学》2018年第2期118-122,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨应用尿肾损伤分子-1（kidney injur ymolecule-1，KIM-1）和血清半胱氨酸蛋白酶抑制剂C（CystainC，Cys—C）预测急诊危重症患者人院7d内发生急性肾损伤（acutekidneyinjury，AKI）的价值。方法入选2015—10～2016—10在北京朝阳医院急诊抢救室连续就诊的危重症患者232例，并且患者就诊时监测血肌酐（sell／mcreatinine，SCr）及尿量均在正常范围，同时测定患者的血清Cys—C、尿KIM-1水平，计算急性生理与慢性健康状况评分Ⅱ（acutephysiologyandchronichealthevaluationII，APACHEII）。自人选之日起，连续监测7dSCr及尿量变化。依据全球改善肾脏病预后组织（kidneydiseaseimprovingglobaloutcomes，KDIGO）临床实践指南中的AKI诊断标准将患者分为AKI组（／Z=99）和非AKI组（／Z：133）。比较AKI组和非AKI组的尿KIM-1、血清Cys—C水平，同时比较AKI组的尿KIM-1和血清Cys—C在不同KDIGO分期中的水平。应用ROC曲线分析尿KIM-1、血清Cys—C对7d内发生AKI的预测价值。结果AKI组患者APACHElI评分明显高于非AKI组[（234-4）分VS．（184-4）分，P〈0．05]。AKI组尿KIM—l、血清Cys—C明显高于非AKI组，分别是[（26．6±9．7）rig／mLVS．（15．9±5．8）ng／mL，P〈0．001]，[（969．3±333．3）ng／mLVS．（632．2±270．4）ng／mL，P〈0．001]。AKI组中，尿KIM-1在KDIGO1期、2期、3期中分别为（19．3±9．3）ng／mL、（25．3±9．1）ng／mL、（31．0±7．7）ng／mL，各组问尿KIM-1水平差异有统计学意义（P〈0．05）。血清Cys—C在KDIGO1期、2期、3期中分别为（857．74-341．8）rig／mL、（956．74-382．6）ng／mL、（1031．74-295．5）ng／mL，1期和3期血清Cys—C水平差异有统计学意义（p〈0．05），其他组间差异无统计学意义。尿KIM-1与血清Cys—C是危重症患者7d内发生AKI的独立预测因素。尿KIM-1预测AKI发生的ROC曲线下面积（0．823）虽然高于血清Cys—C（0．7Objective To investigate the predictive performance of kidney injury molecule - 1 （ KIM - 1 ） and CystainC （ Cys - C ） for acute kidney injury （AKI） , critical patients were hospitalized for seven days in Emergence Department （ED）. Methods From October 2015 to October 2016, 232 critieal patients who have normal serum creatinine （SCr） and urine were admitted to the Emergency Department of Beijing Chaoyang Hospital. SCr, Cys - C, KIM - 1 and APACHE ]1 score were measured when the patients arrived at hospital. A continuous measurement of 7 days was focused on the levels of urine and SCr. In terms of guideline, the patients were classified into two groups ： AKI group （ n = 99 ）and none AKI group （n = 133）. The levels of Cys - C, KIM - 1 and APACHE 11 score were compared between AKI group and non - AKI group. The level of Cys - C, KIM - 1 was compared in AKI group based upon different grades of KDIGO guideline. The predictive performances of KIM - 1 and Cys - C for AKI were analyzed by area under the receiver operating characteristic curve （AUC）. Results APACHE II scores were significantly higher in AKI group than the ones in the non - AKI group （ ng/mL： 23± 4 vs. 18± 4, P 〈 0.05 ）. KIM - 1 and Cys - C were significantly higher in AKI group than the ones in the non - AKI group （ ng/mL：26.6 ± 9.7 vs. 15.9 ±5.8, P 〈 0.001 ; 969.3 ± 333.3 vs. 632.2 ± 270.4, P 〈 0.001, respectively）. In AKI group, a significant difference among grade 1, grade 2 and grade 3 of KIM - 1 was indicated, which was ng/mL ： 19.3 ± 9.3,25.3 ± 9.1, 31.0 ± 7.7, respectively. The level of Cys - C in grade 1, grade 2 and grade 3 were ng/mL ：857.7 ＋ 341.8,956.7 ± 382.6, 1031.7 ± 295. 5, respectively. The level of grade 3 was significant higher than grade 1 but was close to garde 2. The AUC of KIM - 1 and Cys - C were 0. 823 and 0. 781, and no significant difference was shown. Conclusion Monitoring of KIM - 1 and Cys - C concentrations could effectively predict the occurrence of AKI in

关 键 词：肾损伤分子-1(KIM-1) 半胱氨酸蛋白酶抑制剂C(Cys-C) 急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ) 危重病 急性肾损伤(AKI) 

分 类 号：R446.12[医药卫生—诊断学]