尿钙卫蛋白对成人急性肾损伤患者的预后价值分析  

Prognostic value of urinary calprotectin in adult patients with acute kidney injury

作　　者：孔超 秦丽丽[2] 张坤英[2] 孙烜 孙帅 陈秀炎 王健英[2] 吴升芹 孙静姝[2] Kong Chao;Qin Li-li;Zhang Kun-ying;Sun Xuan;Sun Shuai;Chen Xiu-yan;Wang Jian-ying;Wu Sheng-qin;Sun Jing-shu(Weifang Medical University,Weifang 261053,China;Department of Nephrology,Weifang People's Hos-pital,Weifang 261041,China)

机构地区：[1]潍坊医学院,潍坊261053 [2]潍坊市人民医院肾内科,潍坊261041

出　　处：《临床肾脏病杂志》2023年第4期300-306,共7页Journal Of Clinical Nephrology

基　　金：山东省医药卫生科技发展计划项目(2019WS253)。

摘　　要：目的通过观察成人急性肾损伤(acute kidney injury,AKI)患者和健康人群中尿钙卫蛋白(calprotectin,CLP)浓度水平,来探究尿CLP对成人AKI的预后评估价值。方法选择潍坊市人民医院自2020年12月至2021年11月确诊为AKI的患者50例(AKI组)和健康体检中心的健康人群30名(健康对照组),检测两组研究对象的尿CLP、血肌酐、血尿素氮、尿肾损伤因子1(kidney injury molecule-1,KIM-1)、血白蛋白和血红蛋白等指标,同时收集一般资料,比较两组间上述检测指标的差异性。然后对上述AKI组患者随访90 d后进行分组,行肾脏替代治疗(renal replacement therapy,RRT)治疗的患者归为透析组,未行RRT治疗的患者归为非透析组;90 d后死亡的患者归为死亡组,未死亡的患者归为存活组,进行相关指标的比较,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)曲线和AKI患者的生存曲线(乘积极限法),评价尿CLP在成人AKI预后中的价值。结果AKI组患者尿CLP[(65.02±33.75)μg/L比(37.85±17.33)μg/L]、尿KIM-1[(52.21±30.91)ng/L比(30.86±15.38)ng/L]、血肌酐[(538.62±233.91)μmol/L比(62.03±14.27)μmol/L]、血尿素氮[(20.85±9.38)mmol/L比(5.26±1.02)mmol/L]浓度较健康对照组增高。透析组患者的血肌酐[(654.53±218.68)μmol/L比(478.91±221.49)μmol/L]、尿CLP[(92.26±29.26)μg/L比(50.99±26.82)μg/L]和尿KIM-1[(65.69±40.76)ng/L比(45.27±22.04)ng/L]水平较非透析组高,尿CLP预测成人AKI患者进行RRT治疗的诊断界值在76.92μg/L时,ROC曲线下面积为0.850,敏感度和特异度分别为76.5%和87.9%。死亡组和存活组的尿CLP、血红蛋白、尿KIM-1、血尿素氮、收缩压和舒张压水平比较差异均无统计学意义。尿CLP预测成人AKI患者90 d病死率的曲线下面积为0.564,敏感度和特异度分别为76.5%和87.9%。透析组和非透析组90 d病死率差异无统计学意义(P>0.05)。结论成人AKI患者尿CLP水平较健康对照人群显著升高,尿CLP在预�Objective To compare the concentrations of urinary calprotectin(CLP)in adults with acute kidney injury(AKI)and healthy people to explore the prognostic value of urinary calprotectin for adult AKI.Methods From December 2020 to November 2021,50 AKI patients and 30 healthy people at health examination center were selected for detecting urinary Calprotectin,serum creatinine,blood urea nitrogen,urinary kidney injury molecule-1(KIM-1),serum albumin and hemoglobin in two groups.General data were recorded for comparing the differences of the above parameters between two groups.Then the above AKI patients were grouped after 90-day follow-ups.The patients on renal replacement ther-apy(RRT)were classified as dialysis group while those not on RRT as non-dialysis group;The patients dying after 90 days were assigned as death group while those surviving as survival group.The related pa-rameters were compared.Receiver operating characteristic curve(ROC)curve and survival curve(prod-uct limit method)of AKI patients were plotted for evaluating the prognostic value of urinary calprotectin for adult AKI.Results Urinary Calprotectin[(65.02±33.75)μg/L vs(37.85±17.33)μg/L],urinary KIM-1[(52.21±30.91)ng/L vs(30.86±15.38)ng/L],blood creatinine[(538.62±233.91)μmol/L vs(62.03±14.27)μmol/L]and blood urea nitrogen(BUN)[(20.85±9.38)mmol/L vs(5.26±1.02)mmol/L]were higher in AKI group than those in healthy control group.Serum creatinine[(654.53±218.68)μmol/L vs(478.91±221.49)μmol/L],urinary Calprotectin[(92.26±29.26)μg/L vs(50.99±26.82)μg/L]and urinary KIM-1[(65.69±40.76)ng/L vs(45.27±22.04)ng/L]were higher in dialysis group than those in non-dialysis group.The diagnostic threshold of urinary Calprotectin predicting RRT was 76.92μg/L,area under receiver operating characteristic(ROC)curve was 0.850 and the sensitivity and specificity were 76.5%and 87.9%respectively.No significant differences existed in the levels of uri-nary Calprotectin,hemoglobin,urinary KIM-1,blood urea nitrogen,systolic blood pressure or diastolic bloo

关 键 词：急性肾损伤 钙防卫蛋白 预后 

分 类 号：R692[医药卫生—泌尿科学]