尿MMP-9、NGAL、Kim-1、CysC联合检测对脓毒症致急性肾损伤患者病死率的预测价值  

Value of Combination Detection with Urine MMP-9,NGAL,Kim-1 and CysC in Prediction of Mortality Rate in Patients with Acute Kidney Injury Induced by Sepsis

作　　者：徐冬 余健 陈勇[3] 薛翠 宋玲英[1] XU Dong;YU Jian;CHEN Yong;XUE Cui;SONG Ling-ying(Xianning City Central Hospital,first affiliated Hospital of Hubei Institute of Science and Technology,Department of severe Medicine,Xianning 437100,Hubei Province;Xianning City Central Hospital,first affiliated Hospital of Hubei Institute of Science and Technology,Department of Oncology,Xianning 437100,Hubei Province;Xianning Central Hospital,First Affiliated Hospital of Hubei University of Science and Technology,Department of Nephrology,Xianning 437100,Hubei)

机构地区：[1]咸宁市中心医院,湖北科技学院附属第一医院重症医学科,湖北咸宁437100 [2]咸宁市中心医院,湖北科技学院附属第一医院肿瘤科,湖北咸宁437100 [3]咸宁市中心医院,湖北科技学院附属第一医院肾内科,湖北咸宁437100

出　　处：《解放军医药杂志》2019年第9期35-39,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：湖北省自然科学基金资助项目(2014CKB532)

摘　　要：目的探究尿基质金属蛋白酶-9(MMP-9)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子-1(Kim-1)、胱抑素C(CysC)联合检测对脓毒症所致急性肾损伤(AKI)患者28 d病死率的预测价值。方法选取2017年1月—2018年12月收治的300例脓毒症所致AKI患者作为研究对象,按照随访28 d时是否死亡分为死亡组、存活组。比较2组的一般临床资料和入院时尿MMP-9、NGAL、Kim-1、CysC浓度。采用多因素Logistic回归分析影响28 d病死率的危险因素,并评价尿MMP-9、NGAL、Kim-1、CysC及4项联合对28 d死亡的预测价值。结果本组患者28 d病死率为24.00%。AKI分期、脓毒症相关性器官功能衰竭评分、急性生理学与慢性健康状况Ⅱ评分以及尿MMP-9、NGAL、Kim-1、CysC浓度为影响脓毒症所致AKI患者28 d病死率的独立危险因素(P<0.05)。4项尿生化指标联合检测预测脓毒症所致AKI患者28 d病死率的敏感性和特异性分别为86.11%和84.65%,明显高于单独检测。结论脓毒症所致AKI患者会出现不同程度尿MMP-9、NGAL、Kim-1、CysC异常,且均为影响患者28 d病死率的独立危险因素,联合检测对预测预后有较高的应用价值。Objective To investigate value of combination detection with urine matrix metalloproteinase-9(MMP-9),neutrophil gelatinase-associated lipocalin(NGAL),kidney injury molecule 1(Kim-1)and cystatin C(CysC)in prediction of 28 d mortality rate in patients with acute kidney injury(AKI)induced by sepsis.Methods A total of 300 patients with AKI induced by sepsis admitted during January 2017 and December 2018 were divided into death group and survival group according to whether or not death within 28 d of follow up.General data and concentrations of MMP-9,NGAL,Kim-1 and CysC in urine specimens at the time of admission were compared in two groups.Multifactor Logistic regression analysis was used to analyze risk factors affecting 28 d mortality rate,and values of urine MMP-9,NGAL,Kim-1 and CysC detection only and combination detection in prediction of 28 d mortality were evaluated.Results The 28 d mortality rate in the group was 24.00%.AKI staging,score of sepsis-related organ failure,acute physiology and chronic health evaluationⅡscore,urinary MMP-9,NGAL,Kim-1 and CysC concentrations were independent risk factors affecting 28 d mortality rate in sepsis-induced AKI patients(P<0.05).Sensitivity and specificity of combined detection of the four urinary biochemical indicators in prediction of 28 d mortality rate of sepsis-induced AKI patients were 86.11%and 84.65%respectively,which were significantly higher than those by single detection of the four indicators.Conclusion Different degrees of abnormality in urinary MMP-9,NGAL,Kim-1 and CysC can be found in patients with AKI induced by sepsis,and all of them are independent risk factors affecting 28 d mortality rate.Combination detection is of better application value in prediction of prognosis.

关 键 词：基质金属蛋白酶-9 中性粒细胞明胶酶相关脂质运载蛋白 肾损伤分子1 胱抑素C 脓毒症 急性肾损伤 

分 类 号：R631[医药卫生—外科学]