尿基质金属蛋白酶组织抑制剂-2和胰岛素样生长因子结合蛋白-7在脓毒症致AKI中的早期诊断价值  

The early diagnostic value of tissue inhibitor of matrix metalloproteinase-2 and insulin-like growth factor binding protein-7 in sepsis-induced acute kidney injury

作　　者：杨倩[1] 曹伟 吕迪宇 孙宏[1] 刘显东 任慧娟[1] 许明正[1] 李秀华 白建文[1] 唐伦先[1,2] Yang Qian;Cao Wei;Lyu Diyu;Sun Hong;Liu Xiandong;Ren Huijuan;Xu Mingzheng;Li Xiuhua;Bai Jianwen;Tang Lunxian(Department of Emergency Internal Medicine,Shanghai East Hospital Affiliated to Tongji University,Shanghai 200120,China;Department of Emergency Internal Medicine,Shanghai East Hospital Ji'An Hospital,Ji'An 343000,China)

机构地区：[1]同济大学附属东方医院急诊内科,上海200120 [2]上海市东方医院吉安医院急诊内科,343000

出　　处：《中华急诊医学杂志》2020年第9期1167-1172,共6页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金面上项目(81970072);江西省自然科学基金重点项目(20181ACB20016);上海市浦东新区卫计委领先人才项目(PWRI2019‐05);上海市浦东新区卫计委临床高峰学科(急危重症)(PWYgf2018-05)项目。

摘　　要：目的评估尿基质金属蛋白酶组织抑制剂-2(tissue inhibitor of matrix metalloproteinase-2,TIMP-2)和尿胰岛素样生长因子结合蛋白-7(insulin-like growth factor binding protein-7,IGFBP-7)对于脓毒症致急性肾损伤(acute kidney injury,AKI)的早期诊断价值。方法选取2017年9月至2019年6月收治于上海市东方医院急诊ICU和综合ICU的85例脓毒症患者,根据KIDGO诊断标准分为AKI组37例,非AKI组48例,同时设健康对照组20例。收集各组患者的一般临床资料,并于诊断脓毒症0 h、6 h、12 h、1 d、3 d、7 d各采集尿液标本10 mL,采用酶联免疫吸附试验(ELISA)检测各时间点尿TIMP-2和IGFBP-7的水平,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估尿TIMP-2和IGFBP-7对脓毒症AKI的早期诊断价值。结果与对照组相比,脓毒症AKI组的尿TIMP-2和IGFBP-7水平在各时间点均明显升高,差异有统计学意义(P<0.05),而脓毒症非AKI组则差异无统计学意义。AKI组尿TIMP-2和IGFBP-7水平在各时间点均明显高于非AKI组(P<0.05)。ROC曲线分析显示,尿TIMP-2在1 d时AUC达到峰值为0.947,其敏感度、特异度分别为97.5%,81.2%,截断值为151.23 ng/mL。尿IGFBP-7在12 h AUC达到峰值为1,其敏感度、特异度分别为100%,72.8%,截断值为14.91 ng/mL。尿TIMP-2×IGFBP-7联合检测的AUC在12 h时为1.00达到峰值,敏感度和特异度分别为98%和91.5%,截断值为2.09[(ng/mL)2/1000]。结论尿TIMP-2和IGFBP-7的水平升高可以早期预测脓毒症AKI的发生,联合预测的价值优于单个检测。Objective To evaluate the early diagnostic value of tissue inhibitor of matrix metalloproteinase-2(TIMP-2)and insulin-like growth factor binding protein-7(IGFBP-7)in acute kidney injury induced by sepsis.Methods A total of 85 sepsis patients admitted to the EICU and GICU in Shanghai East Hospital from September 2017 to June 2019 were divided into theAKI group(n=37)and the non-AKI group(n=48)according to KIDGO diagnostic criteria,and 20 healthy volunteers were served as the control group.The clinical data were recorded and samples of urine were collected at 0 h,6 h,12 h,1 d,3 d and 7 d post sepsis.The levels of TIMP-2 and IGFBP-7 in the urine were analyzed with ELISA at different time points.Based on the receiver operating characteristic curve(ROC)and the area under the curve(AUC),the early diagnostic value of urinary TIMP-2 and IGFBP-7 in sepsis-induced AKI patients was determined.Results Compared with the control group,the levels of TIMP-2 and IGFBP-7 of the AKI group were significantly higher at the above time points(P<0.05),while those of the non-AKI group showed no significant differences.The levels of TIMP-2 and IGFBP-7 of the AKI group were significantly higher than the those of the non-AKI group(P<0.05).ROC analysis showed that when the AUC of urine TIMP-2 peaked at 1 d,the sensitivity and specificity reached 97.5%and 81.2%,separately with the cutoff value of 151.23 ng/mL.Furthermore,when the AUC of urine IGFBP-7 peaked at 12 h,the sensitivity and specificity reached 100%and 72.8%,separately with the cutoff value of 14.91 ng/mL.Interestingly,when the AUC of combined TIMP-2×IGFBP-7 peaked at 12 h,the sensitivity reached 98.0%and specificity reached 91.5%with the cutoff value of 2.09[(ng/mL)2/1000].There was no significant correlation between the levels of TIMP-2 and IGFBP-7 with SOFA and APACHEⅡscore at 1 d,3 d and 7 d post sepsis in the AKI group(P>0.05).Conclusions Urine TIMP-2 and IGFBP-7 have early diagnostic value in sepsis-induced AKI.Besides,the combination of the two biomarkers have superior pred

关 键 词：脓毒症 急性肾损伤 基质金属蛋白酶组织抑制剂-2 肌酐 胰岛素样生长因子结合蛋白-7 

分 类 号：R459.7[医药卫生—急诊医学]