多发伤早期急性肾损伤新型生物标志物的变化及预测效能研究  

Chang and predictive efficacy of new biomarkers for acute kidney injury in the early stage of multiple trauma

作　　者：刘丹[1] 刘纪宁[1] 朱伦刚[1] 黄彬[1] LIU Dan;LIU Jining;ZHU Lungang;HUANG Bin(Emergency Department,Mianyang Central Hospital,Mianyang,Sichuan 621000,P.R.China)

机构地区：[1]绵阳市中心医院急诊科,四川绵阳621000

出　　处：《华西医学》2021年第11期1528-1532,共5页West China Medical Journal

基　　金：四川省卫生健康委员会科研课题(19PJ113)。

摘　　要：目的探讨血清中中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)、金属蛋白酶组织抑制剂-2(tissue inhibitor of metalloproteinases-2,TIMP-2)、胰岛素样生长因子结合蛋白7(insulin-like growth factor-binding protein 7,IGFBP-7)水平在多发伤早期的变化及其对继发性急性肾损伤(acute kidney injury,AKI)的预测效能。方法前瞻性选取绵阳市中心医院急诊科2020年2月-2021年7月收治的多发伤患者,根据患者伤后72 h是否出现AKI分为AKI组和非AKI组,比较两组患者入院时及伤后12、24、48 h血清NGAL、TIMP-2、IGFBP-7水平,以及急性生理与慢性健康Ⅱ(Acute Pathophysiology and Chronic Health EvaluationⅡ,APACHEⅡ)评分、重症监护病房住院时间、肾脏替代治疗发生率及28 d病死率。结果共纳入51例患者,其中AKI组20例,非AKI组31例。AKI组入院时APACHEⅡ评分[(20.60±3.57) vs.(11.61±3.44)分]、重症监护病房住院时间[(16.75±2.71) vs.(11.13±3.41) d]、肾脏替代治疗发生率(35.0%vs. 0.0%)、28 d病死率(25.0%vs. 3.2%)均高于非AKI组(P<0.05)。AKI组和非AKI组血清NGAL、IGFBP-7水平分别在入院时及伤后12、24、48 h比较差异均有统计学意义(P<0.05)。伤后12 h的NGAL、TIMP-2和IGFBP-7预测继发AKI的受试者工作特征曲线下面积及95%置信区间分别为0.98(0.96,1.00)、0.92(0.83,1.00)和0.87(0.78,0.97)。结论血清NGAL、TIMP-2和IGFBP-7对多发伤继发AKI均具有较高的预测效能,连续监测血清NGAL可作为早期预测多发伤继发AKI的检测指标。Objective To explore the change of serum levels of neutrophil gelatinase-associated lipocalin(NGAL), tissue inhibitor of metalloproteinases-2(TIMP-2), and insulin-like growth factor-binding protein 7(IGFBP-7) in the early stage of multiple trauma, and their predictive efficacy for acute kidney injury(AKI). Methods The multiple trauma patients admitted between February 2020 and July 2021 were prospectively selected, and they were divided into AKI group and non-AKI group according to whether they developed AKI within 72 h after injury. The serum levels of NGAL, TIMP-2, and IGFBP-7 measured at admission and 12, 24, and 48 h after injury, the Acute Pathophysiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) score, intensive care unit duration, rate of renal replacement therapy, and 28-day mortality rate were compared between the two groups. Results A total of 51 patients were included, including 20 in the AKI group and 31 in the non-AKI group. The APACHE Ⅱ at admission(20.60±3.57 vs. 11.61±3.44), intensive care unit duration [(16.75±2.71) vs.(11.13±3.41) d], rate of renal replacement therapy(35.0% vs. 0.0%), and 28-day mortality rate(25.0% vs. 3.2%) in the AKI group were higher than those in the non-AKI group(P<0.05). The serum levels of NGAL and IGFBP-7 at admission and 12, 24, and 48 h after injury in the AKI group were all higher than those in the non-AKI group(P<0.05). For the prediction of AKI, the areas under receiver operating characteristic curves and 95% confidence intervals of serum NGAL, TIMP-2 and IGFBP-7 12 h after injury were 0.98(0.96, 1.00), 0.92(0.83, 1.00), and 0.87(0.78,0.97), respectively. Conclusion Serum NGAL, TIMP-2, and IGFBP-7 have high predictive efficacy for AKI secondary to multiple trauma, and continuous monitoring of serum NGAL can be used for early prediction of AKI secondary to multiple trauma.

关 键 词：多发伤 急性肾损伤 新型生物标志物 预测效能 

分 类 号：R692[医药卫生—泌尿科学] R641[医药卫生—外科学]