尿α1-微球蛋白及尿N-乙酰-β-D-氨基葡萄糖苷酶对脓毒症急性肾损伤的早期预测价值  

Early predictive value of urinaryα1-microglobulin and urinary N-acetyl-β-D-glucosaminidase in sepsis-induced acute kidney injury

作　　者：郭颖 沈业周 张俭[1] GUO Ying;SHEN Yezhou;ZHANG Jian(Department of Critical Care Medicine,The Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China)

机构地区：[1]杭州师范大学附属医院重症医学科,浙江杭州310015

出　　处：《健康研究》2022年第4期455-460,共6页Health Research

基　　金：2019年杭州市科技发展计划项目(20191203B95)。

摘　　要：目的探讨尿α1-微球蛋白(α1-M)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)对脓毒症急性肾损伤的早期预测价值。方法采用回顾性临床研究方法,选择符合纳入标准的脓毒症/脓毒性休克患者共60例,根据脓毒症确诊7天内是否发生肾损伤,分为脓毒症肾损伤组(26例)和脓毒症非肾损伤组(34例)。收集并比较患者被确诊为脓毒症时的24 h内的尿α1-M、尿NAG、尿β2-微球蛋白(β2-M)、尿微量白蛋白(MA)、尿肌酐(UCr)、尿视黄醇结合蛋白(RBP)、血肌酐(SCr)的实验室结果。结果脓毒症肾损伤组与脓毒症非肾损伤组的尿α1-M、尿NAG、尿β2-M、尿MA、尿RBP、SCr之间差异均有统计学意义(P<0.05),这些指标用于预测脓毒症是否发生肾损伤的曲线下面积(AUC)分别为0.864、0.827、0.735、0.693、0.705、0.824;联合尿α1-M和尿NAG,AUC为0.916。结论尿α1-M、尿NAG对预测脓毒症发生急性肾损伤存在早期预测价值,比血肌酐更优越,且二者联合可进一步提高早期预测价值。Objective To explore the early predictive value of urinaryα1-microglobulin(α1-M)and urinary N-acetyl-β-D-glucosaminidase(NAG)in patients with sepsis-induced acute kidney injury.Methods A total of 60 patients with sepsis/septic shock who met the inclusion criteria were selected by retrospective clinical research.Whether the renal injury occurred within seven days after the diagnosis of sepsis,they were divided into the sepsis renal injury group(26 cases)and the sepsis non-renal injury group(34 cases).The laboratory results of urinaryα1-M,urinary NAG,urinaryβ2-microglobulin(β2-M),urinary microalbumin(MA),urinary creatinine(UCr),urinary retinol-binding protein(RBP),and serum creatinine(SCr)within 24 hours were collected and compared when the patients were diagnosed as sepsis.Results There were statistically significant differences in urineα1-M,urine NAG,urineβ2-M,urine MA,urine RBP,and SCr between the sepsis-induced acute kidney injury group and sepsis non-kidney injury group(P<0.05).These indicators'areas under the curve(AUC)for predicting whether the renal injury occurred in sepsis were 0.864,0.827,0.735,0.693,0.705,and 0.824,respectively.The AUC of the combination of urinaryα1-M and urinary NAG was 0.916.Conclusions Urinaryα1-M and urinary NAG have an early predictive value of sepsis-induced acute kidney injury,which is superior to serum creatinine,and the combination of the two can further improve the early predictive value.

关 键 词：脓毒症 急性肾损伤 Α1-微球蛋白 N-乙酰-Β-D-氨基葡萄糖苷酶 

分 类 号：R692.5[医药卫生—泌尿科学]