尿金属蛋白酶组织抑制剂-2·胰岛素样生长因子结合蛋白-7对脓毒血症患者急性肾损伤和肾替代治疗的早期预测价值  

The early predictive value of tissue inhibitor of metalloproteinase-2·insulin-like growth factor binding protein-7 in urine for acute kidney injury and renal replacement therapy in patients with sepsis

作　　者：唐凯宏 金英玉[1] TANG Kaihong;JIN Yingyu(The First Affiliated Hospital of Harbin Medical University,Harbin,Heilongjiang 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院,黑龙江哈尔滨150001

出　　处：《国际检验医学杂志》2021年第4期476-480,共5页International Journal of Laboratory Medicine

摘　　要：目的探讨尿金属蛋白酶组织抑制剂-2(TIMP-2)·胰岛素样生长因子结合蛋白-7(IGFBP-7)对脓毒血症患者急性肾损伤(AKI)和肾替代治疗(RRT)的早期预测价值。方法选取121例脓毒血症患者和24例体检健康者,后者作为对照组。记录上述人群一般资料,检测并比较入院时的血肌酐(sCr)、乳酸脱氢酶(LDH)、C-反应蛋白(CRP)、降钙素原(PCT)、白细胞计数(WBC)、D-二聚体(D-D)、纤维蛋白原(Fib)、TIMP-2、IGFBP-7水平。检测脓毒血症患者入住ICU后6、12、24、36 h尿TIMP-2、尿IGFBP-7,计算尿TIMP-2·IGFBP-7。将所有脓毒血症患者根据是否发生AKI分为AKI组和非AKI组,采用受试者工作特征曲线(ROC)及曲线下面积(AUC)判断不同时间点尿TIMP-2·IGFBP-7对AKI的预测价值,确定最佳临界值,分析尿TIMP-2·IGFBP-7与AKI的关系。将AKI患者分为肾替代治疗(RRT)组和非RRT组,比较两组间尿TIMP-2·IGFBP-7,利用ROC曲线及AUC判断不同时间点尿TIMP-2·IGFBP-7对RRT的预测价值,确定最佳临界值。结果121例脓毒血症患者中发生AKI 45例。AKI组、非AKI组LDH、CRP、PCT、WBC、D-D、Fib水平均高于对照组(P<0.05),非AKI组序贯器官衰竭评估(SOFA)评分、血浆输注量、RBC输注量均低于AKI组,发病至入住ICU时间长于AKI组,差异均有统计学意义(P<0.05);入住ICU后6、12、24、36 h尿TIMP-2·IGFBP-7与AKI的发生呈正相关(r=0.206、0.383、0.415、0.462,均P<0.05),随着时间推移r增大。入住ICU后6、12、24、36 h尿TIMP-2·IGFBP-7用于预测AKI的AUC分别为0.740、0.788、0.795、0.877,最佳临界值分别为0.415、0.485、0.591、0.825 ng/(mL^2·10^3);RRT组尿TIMP-2·IGFBP-7高于非RRT组,入住ICU后6、12、24、36 h尿TIMP-2·IGFBP-7用于预测RRT的AUC分别为0.575、0.804、0.883、0.809,最佳临界值分别为0.518、0.825、0.917、1.015 ng/(mL^2·10^3)。结论尿TIMP-2·IGFBP-7是脓毒血症患者AKI发生和AKI患者行RRT的独立预测指标,具有较好的早期预测价值。Objective To explore the early predictive value of tissue inhibitor of metalloproteinase-2(TIMP-2)·insulin-like growth factor binding protein-7(TIMP-2)in urine for acute kidney injury(AKI)and renal replacement therapy(RRT)in patients with sepsis.Methods A total of 121 patients with sepsis were enrolled in the study and 24 healthy individuals were enrolled as control group.The general data of the above population were recorded,and the levels of serum creatinine(sCr),lactate dehydrogenase(LDH),C-reactive protein(CRP),procalcitonin(PCT),white blood cell count(WBC),D-Dimer(D-D),fibrinogen(Fib),TIMP-2 and IGFBP-7 were detected and compared.Urinary TIMP-2 and IGFBP-7 were detected at 6,12,24 and 36 h after admission to ICU,and urinary TIMP-2·IGFBP-7 were calculated.All patients with sepsis were divided into AKI group and non-AKI group according to the occurrence of AKI.Receiver operating characteristic(ROC)curve and the area under curve(AUC)were used to determine the predictive value of urinary TIMP-2·IGFBP-7 for AKI at different time points,determine the cut-off value,and analyze the relationship between urinary TIMP-2·IGFBP-7 and AKI.AKI patients were divided into renal replacement therapy(RRT)group and non-RRT group.The urinary TIMP-2·IGFBP-7 values were compared between the two groups.The ROC curve and AUC were used to determine the predictive value of urinary TIMP-2·IGFBP-7 at different time points for RRT and determine the best cut-off value.Results There were 45 cases of AKI among 121 patients with sepsis.The LDH,CRP,PCT,WBC,DD,and Fib in the AKI group and the non-AKI group were higher than those in the control group(P<0.05).The SOFA scores,plasma infusion volume,and RBC infusion volume in the non-AKI group were lower than those in the AKI group.The time from onset to admission to ICU were longer than that in AKI group,the differences were statistically significant(P<0.05);urinary TIMP-2·IGFBP-7 was positively correlated with the occurrence of AKI at 6,12,24,and 36 h after admission to the ICU(r=0.206,0.3

关 键 词：脓毒血症 肾替代治疗 金属蛋白酶组织抑制剂-2 胰岛素样生长因子结合蛋白-7 急性肾损伤 

分 类 号：R446.1[医药卫生—诊断学]