尿肾脏损伤因子-1与产后出血所致急性肾损伤的关系及诊断价值  

The Diagnostic Value of Urine Kidney Injury Molecule-1 in Patients with Acute Kidney Injury of Postpartum Hemorrhage

作　　者：李平华[1] LI Ping-hua(Department of Obstetrical,The General Hospital of Hebei Jizhong energy xingtai mining GroupCo,LTD,Xingtai,Hebei,05400)

机构地区：[1]河北省冀中能源邢台矿业集团有限责任公司总医院产科,054000

出　　处：《临床输血与检验》2018年第4期407-411,406,共6页Journal of Clinical Transfusion and Laboratory Medicine

摘　　要：目的探讨尿肾脏损伤因子-1(KIM-1)与产后出血所致急性肾损伤(AKI)的关系及诊断价值。方法回顾性分析2013年7月～2016年5月医院收治的185例产后出血孕产妇临床资料,按照AKI诊断标准分为AKI组46例和非AKI组139例,采用尿试纸试验检查患者尿隐血和尿蛋白含量,碱性苦味酸法检测血肌酐(SCr)值,酶联免疫吸附试验检测尿KIM-1水平。Logistic回归分析影响AKI的危险因素,利用受试者工作特征曲线(ROC)预测KIM-1及其他指标对AKI的诊断价值。结果 AKI组SCr、尿KIM-1、产后出血量、妊娠糖尿病发生率、妊娠高血压发生率、胎盘早剥发生率、先兆子痫发生率、尿蛋白阳性率、尿隐血阳性率均明显高于非AKI组,差异有统计学意义(均P<0.05)。相关分析显示,AKI患者尿KIM-1水平与产后出血量、尿蛋白、尿隐血、SCr呈明显正相关(r=0.798,0.630,0.600,0.887,均P<0.05),与其余指标的相关性无统计学意义(P>0.05)。Logistic多因素回归分析显示,尿蛋白、尿隐血、SCr、尿KIM-1是影响AKI患者的危险因素(均P<0.05)。ROC曲线分析显示,尿KIM-1诊断AKI的最佳临界值为5.21 ng/mL,敏感度为78.4%,特异度为82.9%,ROC曲线下面积(AUC)为0.811(95%CI:0.649～0.929,P<0.05),尿KIM-1诊断AKI的AUC高于尿蛋白(AUC:0.732,95%CI:0.600～0.864,P<0.05)、尿隐血(AUC:0.758,95%CI:0.634～0.882,P<0.05)、SCr(AUC:0.676,95%CI:0.539～0.813,P<0.05)。结论尿KIM-1是影响AKI的危险因素,检测尿KIM-1能够为诊断AKI提供参考。Objective To explore the correlation and its diagnostic value between urine kidney injury molecule-1 （KIM-1） levels and acute kidney injury （AKI） in the patients with postpartum hemorrhage. Methods Clinical data of 185 cases of postpartum hemorrhage were retrospectively analysed,according to AKI diagnostic criteria. The patients weredivided into 46 cases of AKI group and 139 cases of non-AKI group. The urine occult blood and protein were detected by urinepaper test,serum creatinine level was detected by alkaline picric acid method,urine KIM-1 level was determined by ELISA.The AKI risk factors was analysed by logistic regression. The diagnostic value of urine KIM-1 and other indicators for AKI were evaluated by receiver operating curve （ROC）. Results The SCr,urine KIM-1,postpartum hemorrhage volume and the rates of gestational diabetes,gestational hypertension,placental abruption,preeclampsia,positive urinary protein,positive urine occult blood in AKI group were significantly higher than those in non-AKI group （all P 〈0.05）. The urineKIM-1 level was positively correlated with urine protein,urine occult blood and SCr in AKI patients （r =0.798,0.630,0.600,0.887,P 〈0.05）,and no correlation of other indexes were found. Logistic multivariate regression analysis showed that urine KIM-1,protein,occult blood,and SCr were risk factors for AKI （all P 〈0.05）. The optimal cut-off value of urine KIM-1 as an indicator for AKI diagnosis was projected to be 5.21 ng/mL,which yielded a sensitivity of 78.4% and aspecificity of 82.9% with an area under the curve （AUC） of 0.811 （95%CI：0.649～0.929,P 〈0.05）. The AUC of urineKIM-1 for KAI diagnosis was higher than urine protein （AUC：0.732,95%CI：0.600～0.864,P 〈0.05）,urine occultblood （AUC：0.758,95%CI：0.634～0.882,P 〈0.05）,and SCr （AUC：0.676,95%CI：0.539～0.813,P 〈0.05）.Conclusion Urinary KIM-1 is a risk factor for AKI and detection of KIM-1 may provide a reference for the diagnosis of AKI.

关 键 词：肾脏损伤因子-1 产后出血 急性肾损伤 诊断 

分 类 号：R446.1[医药卫生—诊断学] R692[医药卫生—临床医学]