多项生物学标志物联合检测对老年重症病人合并急性肾损伤早期的诊断价值  

Value of combined detection of multiple biomarkers in the early diagnosis of acute kidney injury in elderly critically ill patients

作　　者：杨云飞[1] 王爱田[1] 赵华灵[1] 付珊珊 张建军[1] 梁静涛[1] 李晓岚[1] YANG Yunfei;WANG Aitian;ZHAO Hualing;FU Shanshan;ZHANG Jianjun;LIANG Jingtao;LI Xiaolan(Department of Intensive Care Medicine,Kailuan General Hospital,Tangshan,Hebei 063000,China)

机构地区：[1]开滦总医院重症医学科,河北唐山063000

出　　处：《安徽医药》2023年第7期1408-1412,共5页Anhui Medical and Pharmaceutical Journal

基　　金：2022年度河北省医学科研课题计划(20221584)。

摘　　要：目的探究多项生物学标志物联合检测在老年重症病人合并急性肾损伤(AKI)早期诊断中的价值。方法选取2020年5月至2021年6月开滦总医院收治的150例老年重症病人作为研究对象,根据AKI发生与否分为AKI组(n=56)与非AKI组(n=94)。比较两组临床资料、入住ICU即刻、4 h、12 h、24 h尿[金属蛋白酶阻滞抑制剂-2(TIMP-2)]×[胰岛素样生长因子结合蛋白-7(IGFBP7)],分析不同时间点[TIMP-2]×[IGFBP-7]与重症病人AKI及预后不良的关系,绘制受试者操作特征曲线(ROC曲线),评价不同时间点[TIMP-2]×[IGFBP-7]对重症病人AKI的诊断价值。结果AKI组年龄、高血压、APACHEⅡ评分、血乳酸、肌酐、降钙素原、谷丙转氨酶、动脉血氧分压、动脉血二氧化碳分压与非AKI组比较,差异有统计学意义(P<0.05);AKI组ICU 4 h、12 h、24 h尿[TIMP-2]×[IGFBP-7]分别为(0.45±0.08)、(0.68±0.17)、(0.89±0.27)、(1.13±0.32)(μg/L)^(2)均高于非AKI组(0.43±0.07)、(0.50±0.14)、(0.54±0.18)、(0.75±0.21)(μg/L)2(P<0.05);logistic回归方程调整年龄、高血压、APACHEⅡ评分、血乳酸、肌酐、降钙素原、谷丙转氨酶、动脉血氧分压、动脉血二氧化碳分压等其他混杂因素后,结果显示,ICU4 h、12 h、24 h尿[TIMP-2]×[IGFBP-7]均为重症病人AKI发生独立危险因素(P<0.05);绘制不同时间点[TIMP-2]×[IGFBP-7]对重症病人AKI诊断价值的ROC曲线,结果显示ICU 4 h、12 h、24 h尿[TIMP-2]×[IGFBP-7]对重症病人AKI诊断价值的曲线下面积(AUC)分别为0.778、0.830、0.875;Cox单因素、多因素分析均显示ICU 4 h、12 h、24 h尿[TIMP-2]×[IGFBP-7]与重症病人预后不良有关(P<0.05)。结论老年重症病人入住ICU后4 h、12 h、24 h尿[TIMP-2]×[IGFBP-7]水平对AKI具有早期评估价值,可作为AKI早期预警、诊断指标,值得临床推广与应用。Objective To explore the value of combined detection of multiple biomarkers in the early diagnosis of acute kidney injury(AKI)in elderly critically ill patients.Methods One hundred and fifty elderly critically ill patients admitted to Kailuan General Hospital from May 2020 to June 2021 were selected as the research subjects.According to the occurrence of AKI,they were divided into AKI group(n=56)and non-AKI group(n=94).The clinical data and immediately after admission to ICU,4 h,12 h,24 h urine[metalloproteinase blocker-2(TIMP-2)]×[insulin-like growth factor binding protein-7(IGFBP7)]value of the two groups were compared.The relationship between[TIMP-2]×[IGFBP-7]value at different time points and AKI and poor prognosis in severe patients was analyzed,receiver operating characteristic(ROC)curve was drawn,and the diagnostic value of different time points[TIMP-2]×[IGFBP-7]in severe patients with AKI was evaluated.Results The differences in age,hypertension,APACHEⅡ score,blood lactic acid,creatinine,procalcitonin,alanine aminotransferase,arterial partial pressure of oxygen,arterial partial pressure of carbon dioxide between the AKI group and the non-AKI group were statistically significant(P<0.05).The urine[TIMP-2]×[IGFBP-7]values at 4 h,12 h,24 h in ICU of AKI group were(0.45±0.08)(μg/L)2,(0.68±0.17)(μg/L)2,(0.89±0.27)(μg/L)2,and(1.13±0.32)(μg/L)^(2),respectively,which were higher than those of the non AKI group(0.43±0.07)(μg/L)2,(0.50±0.14)(μg/L)2,(0.54±0.18)(μg/L)2,and(0.75±0.21)(μg/L)2(P<0.05).Logistic regression equation showed that after adjusting other confounding factors such as age,hypertension,APACHEⅡ score,blood lactate,creatinine,procalcitonin,alanine transaminase,arterial oxygen partial pressure and arterial blood carbon dioxide partial pressure,the urine[TIMP-2]×[IGFBP-7]value at 4 h,12 h,24 h in ICU were independent risk factors for AKI in critically ill patients(P<0.05);ROC curves of the diagnostic value of urine[TIMP-2]×[IGFBP-7]value at different time points for AKI in crit

关 键 词：危重病 急性肾损伤 金属蛋白酶阻滞抑制剂-2 胰岛素样生长因子结合蛋白-7 重症监护病房 

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