失代偿期乙型肝炎肝硬化患者尿液视黄醇结合蛋白水平及其临床意义探讨  

Urineretinol binding protein levels in patients with hepatitis B-induced decompensated liver cirrhosis as the index for acute kidney injury

作　　者：王晶晶[1] 李春涛[1] 周卫真[2] Wang Jingjing;Li Chuntao;Zhou Weizhen(Department of Gastroenterology,Shunyi District Hospital,Affiliated to Capital Medical University,Shunyi 101300,Beijing)

机构地区：[1]中国医科大学附属北京市顺义区医院消化内科,北京市101300 [2]首都医科大学附属北京朝阳医院消化内科

出　　处：《实用肝脏病杂志》2020年第1期74-77,共4页Journal of Practical Hepatology

基　　金：北京市自然科学基金资助项目(编号:7151729)

摘　　要：目的探讨检测尿液视黄醇结合蛋白(RBP)水平诊断失代偿期乙型肝炎肝硬化患者并发急性肾损伤(AKI)的价值。方法2015年5月~2018年5月我院救治的112例失代偿期乙型肝炎肝硬化患者和同期健康体检者35例,采用酶联免疫吸附法检测受试者尿液RBP水平,应用ROC曲线并计算曲线下面积(AUC)分析尿RBP诊断失代偿期肝硬化患者并发AKI的价值。结果失代偿期肝硬化患者尿液RBP水平为(2.2±1.0)mg/L,显著高于对照组【(0.3±0.1)mg/L,P<0.05】;28例重度腹水患者尿RBP、尿微量白蛋白(mAlb)和估算的肾小球滤过率(eGFR)水平分别为(3.2±0.6)mg/L、(24.9±7.7)mg/L和(58.3±13.9)mL/min/1.73 m 2,其中尿RBP和尿mAlb水平均显著高于31例轻度腹水组或53例中度腹水组,而eGFR水平显著低于轻度腹水和中度腹水患者,差异有统计学意义(P<0.05);重度腹水患者sCr水平与中度腹水组比较,差异无统计学意义【(92.8±14.0)μmol/L对(89.8±14.4)μmol/L,P>0.05】,但显著高于轻度腹水组【(80.4±11.9)μmol/L,P<0.05】;单因素分析结果显示,43例继发AKI组与69例未继发AKI组在血小板计数和上消化道出血发生率方面比较,差异无统计学意义(P>0.05),而在mAlb、eGFR、RBP、血钠、TBIL、白细胞计数、PTA、NH 3+、肝性脑病和自发性腹膜炎方面比较,差异有统计学意义(P<0.05);尿RBP诊断失代偿期肝硬化患者继发AKI的AUC为0.856(95%CI:0.777~0.915),对应的最佳截断点为2.6 mg/L,其诊断的敏感度和特异度分别为81.4%和84.1%。结论尿RBP能反映失代偿期肝硬化病情的严重程度,甚至可作为继发AKI的标志物。Objective The purpose of this study was to investigate urine retinol binding protein(RBP)levels in patients with hepatitis B-induced decompensated liver cirrhosis(LC)as the index for acute kidney injury(AKI).Methods 112 patients with decompensated hepatitis B liver cirrhosis and 35 healthy individuals were recruited in our hospital between May 2015 and May 2018,and urine RBP levels were detected by ELISA.The diagnostic efficacy of urine RBP for AKI was evaluated by area under the ROC(AUC).Results Urine RBP level in patients with decompensated cirrhosis was(2.2±1.0)mg/L,significantly higher than[(0.3±0.1)mg/L,P<0.05]in healthy persons;urinary RBP,urinary microalbumin(mAlb)and estimated glomerular filtration rate(eGFR)in 28 patients with severe ascites were(3.2±0.6)mg/L,(24.9±7.7)mg/L and(58.3±13.9)mL/min/1.73 m 2,among them,the urinary RBP and urinary mAlb levels were significantly higher than those in the 31 mild ascites or 53 moderate ascites,and the eGFR level was significantly lowerthan that in patients with mild ascites or moderate ascites,with the differences were statistically significant(P<0.05);there was no significant difference as respect to sCr level between patients with severe ascites and moderate ascites[(92.8±14.0μmol/L vs.(89.8±14.4)μmol/L,P>0.05],but they were much higher than that in mild ascites[(80.4±11.9)μmol/L,P<0.05];univariate analysis showed that there were no significant differences in platelet counts and upper gastrointestinal bleeding between 43 patients with secondary AKI and 69 without(P>0.05);there were significant differences in mAlb,eGFR,RBP,blood sodium,serum bilirubin,white blood cell counts,prothrombin time activity,NH3+,hepatic encephalopathy and spontaneous bacterial peritonitis between the two groups(P<0.05);the AUC of urine RBP in the diagnosis of AKI was 0.856(95%CI:0.777-0.915),with the cut-off-value of 2.6 mg/L,sensitivity of 81.4%and specificity of 84.1%.Conclusion Urine RBP level might be used to diagnose AKI as it reflect the severity of ascites in patients

关 键 词：肝硬化 视黄醇结合蛋白 急性肾损伤 诊断 

分 类 号：R575.2[医药卫生—消化系统] R512.62[医药卫生—内科学]