血清胱抑素C联合尿中性粒细胞明胶酶相关脂质运载蛋白对脓毒症合并急性肾损伤的早期诊断价值  

Value of combined detection of cystatin C and neutmphil gelatinase-associated lipocalin in the early diagnosis of sepsis complicated with acute renal injury

作　　者：吴丹[1] WU Dan(Department of Emergency,Nanjing First Hospital,Nanjing Medical University,Nanjing 210001,Jiangsu,China.)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)急诊科,江苏南京210001

出　　处：《上海医学》2020年第12期745-750,共6页Shanghai Medical Journal

摘　　要：目的探讨血清胱抑素C(sCys-C)联合尿中性粒细胞明胶酶相关脂质运载蛋白(uNGAL)水平在脓毒症合并急性肾损伤(AKI)患者中的早期诊断价值。方法收集2017年1月-2019年5月南京医科大学附属南京医院急诊ICU收治的205例脓毒症患者临床资料,将合并AKI的112例患者设为AKI组,未发生AKI的93例患者设为非AKI组。分别留取入选患者确诊脓毒症后0、6、12、24、48、72 h的空腹血液和尿液标本,测定各时间点患者血清肌酐(sCr)、sCys-C和uNGAL水平,绘制ROC并计算AUC。结果两组患者的性别构成、年龄、慢性基础病比例的差异均无统计学意义(P值均>0.05)。AKI组急性生理学与慢性健康状况评价Ⅱ(APACHEⅡ)评分、死亡病例数比例显著高于非AKI组(P值均<0.05);AKI组血流感染和消化系统感染患者比例均显著高于非AKI组(P值均<0.05)。AKI组sCys-C和uNGAL分别在确诊脓毒症后24、12 h达峰值水平,在12~72 h各时间点与非AKI组的差异均有统计学意义(P值均<0.05)。sCr的AUC为0.820 (95%CI为0.762~0.878),其灵敏度和特异度分别为0.791和0.753;以sCys-C值1.95 mg/L为诊断截点预测脓毒症患者合并AKI的灵敏度和特异度分别为0.755和0.889,AUC为0.887(95%CI为0.841~0.933);以uNGAL值231.1μg/L为诊断截点时的灵敏度和特异度分别为0.873和0.802,AUC为0.897(95%CI为0.853~0.941);uNGAL联合sCys-C诊断的灵敏度和特异度分别为0.955和0.963,AUC为0.984(95%CI为0.978~0.991)。Pearson相关分析显示,uNGAL、sCys-C的表达与sCr皆呈正相关(r=0.803、0.777,P值均<0.001)。结论脓毒症合并AKI患者sCys-C与uNGAL水平显著升高,两者诊断脓毒症合并AKI的灵敏度和特异度均高于sCr,且两者联合应用能更早、更准确地预测AKI的发生。Objective To investigate the value of serum cystatin-C(sCys-C) and urine nuetrophil gelatinase-associated lipocalin(uNGAL) in early prediction of sepsis complicated with acute kidney injury(AKI). Methods A total of 205 patients with sepsis who were hospitalized in the Emergency Intensive Care Unit of Nanjing First Hospital from January 2017 to May 2019 were enrolled in the present study;112 patients complicated with AKI were assigned to AKI group;and the rest 93 patients without AKI were assigned to non-AKI group. The blood samples and urine samples of the patients were taken at 0 h, 6 h, 12 h, 24 h, 48 h and 72 h after the diagnosis of sepsis, and the levels of serum creatinine(sCr), sCys-C and uNGAL were determined at each time point. Receiver operating characteristic(ROC) curves and area under the curve(AUC) were employed to determine the optimal cut-off values of diagnosis of AKl with sCys-C and uNGAL. Results There were no significant differences in the gender, age, or chronic disease between the two groups(all P>0.05). The acute physiology and chronic health evaluation(APACHE II) score and mortality in AKI group were significantly higher than those in non-AKI group(both P<0.05). There were more patients with blood infections and gastorintestinal infections in AKI group compared with non-AKI group(both P<0.05). The levels of sCys-C and uNGAL in AKI group peaked at 24 h and 12 h after the diagnosis of sepsis in AKI group, and the values during 12-72 h were significantly different from those in non-AKI group(P<0.05). The sensitivity and specificity of sCr in the prediction of AKI in sepsis patients were 0.791 and 0.753, respectively. When sCys-C level was 1.95 mg/L, which was taken as the diagnostic cut-off point, the sensitivity and specificity of sCys-C in the prediction of AKI in sepsis patients were 0.755 and 0.889, respectively, with the AUC being 0.887(95%CI: 0.841-0.933). When uNGAL level was 231.1 μg/L, which was taken as the diagnostic cut-off point, the sensitivity and specificity of uNGAL were 0.87

关 键 词：脓毒症 急性肾损伤 血清胱抑素C 尿中性粒细胞明胶酶相关脂质运载蛋白 

分 类 号：R692[医药卫生—泌尿科学] R459.7[医药卫生—外科学]