尿IGFBP-7对危重症患儿急性肾损伤的早期预测价值  

Early predictive value of urinary IGFBP-7 in acute kidney injury in critically ill children

作　　者：戴小妹 陈娇[2] 陆春久 王雪芹[1] 柏振江[2] 李艳红[3,1] DAI Xiaomei;CHEN Jiao;LU Chunjiu;WANG Xueqin;BAI Zhenjiang;LI Yanhong(Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou 215000, Jiangsu, China;Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou 215000, Jiangsu, China;Department of Nephrology, Children's Hospital of Soochow University, Suzhou 215000, Jiangsu, China)

机构地区：[1]苏州大学附属儿童医院肾脏科,江苏苏州215000 [2]苏州大学附属儿童医院重症医学科,江苏苏州215000 [3]苏州大学附属儿童医院儿科临床研究院,江苏苏州215000

出　　处：《临床儿科杂志》2019年第4期277-281,共5页Journal of Clinical Pediatrics

基　　金：国家自然科学基金(No.81741054);江苏省科技支撑计划(No.社会发展BE2016675);江苏省自然科学基金(No.BK 20171217);江苏省妇幼健康重点人才(No.FRC 201738);苏州市临床重点病种诊疗技术专项(No.LCZX 201611);苏州市科技发展计划(No.SYS201760);江苏省高校研究生创新计划(No.SJCX17_0654)

摘　　要：目的探讨尿胰岛素样生长因子结合蛋白7(IGFBP-7)对危重症患儿急性肾损伤(AKI)的早期预测价值。方法选择2012年5月至8月儿童重症监护病房(PICU)收治的患儿为研究对象。分为轻度AKI(AKI 1期)、严重AKI(AKI2和3期)和非AKI组。检测入PICU第一个24小时尿IGFBP-7水平,并于入PICU 24小时内行儿童死亡风险Ⅲ(PRISMⅢ)评分。以多因素logistic回归分析评估在校正混杂因素后尿IGFBP-7与AKI的关系,用受试者工作特征曲线(ROC)及曲线下面积(AUC)评价尿IGFBP-7对危重症患儿AKI的早期预测价值。结果共纳入危重症患儿144例,21例(14.6%)在样本采集120小时内发生AKI,其中严重AKI 11例。严重AKI组入PICU第一个24小时的尿IGFBP-7水平、PRISMⅢ评分均高于轻度AKI及无AKI组,差异均有统计学意义(P<0.05)。Logistic回归分析显示,在校正年龄、体质量、PRISMⅢ评分后,尿IGFBP-7是严重AKI的独立危险因素(OR=2.93,95%CI:1.07～8.03,P=0.037),预测危重症患儿严重AKI的AUC值为0. 79(95%CI:0. 66～0. 92,P=0. 001)。结论尿IGFBP-7是危重症患儿严重AKI的独立预测指标,具有早期预测价值。Objective To explore the early predictive value of urinary insulin-like growth factor binding protein 7 (IGFBP-7) in acute kidney injury (AKI) in critically ill children. MethodThe children admitted to PICU from May to August 2012 were selected as the research subjects. They were divided into mild AKI (AKI phase 1), severe AKI (AKI phase 2 and 3) and non-AKI groups. The IGFBP-7 levels in first 24-hour urinary were detected and the pediatric risk of mortality Ⅲ(PRISM Ⅲ) score was calculated 24 hours after admission. Multivariate logistic regression analysis was used to evaluate the relationship between urinary IGFBP-7 and AKI after correction of confounding factors. The early predictive value of urinary IGFBP-7 for AKI in critically ill children was evaluated by ROC and AUC. ResultsA total of 144 children with critical illness were enrolled. AKI occurred in 21 children (14.6%) within 120 hours after sample collection, including 11 children with severe AKI. The urinary IGFBP-7 level and PRISM III score in the first 24 hours after PICU admission were higher in severe AKI group than those in mild AKI group and non-AKI group, and differences were significant (both P<0.05). Logistic regression analysis showed that urinary IGFBP-7 was an independent risk factor for severe AKI (OR=2.93, 95%CI: 1.07~8.03, P=0.037) after adjusting for age, body mass and PRISM III score, and its predicting value was 0.79 by AUC (95%CI: 0.66~0.92, P=0.001). Conclusion Urinary IGFBP-7 is an independent predictor of severe AKI in critically ill children and has early predictive value.

关 键 词：急性肾损伤 胰岛素样生长因子结合蛋白7 儿童死亡风险评分Ⅲ 危重症患儿 

分 类 号：R720.597[医药卫生—急诊医学] R726.9[医药卫生—儿科]