OLFM-4、SCUBE-1联合L-FABP对重症肺炎患者并发急性肾损伤的早期诊断价值  

The early diagnostic value of OLFM-4,SCUBE-1 combined with L-FABP in patients with severe pneumonia complicated with acute kidney injury

作　　者：钟婉红 许俊旭 王聪 陈兰 Zhong Wanhong;Xu Junxu;Wang Cong;Chen Lan(Department of Respiratory and Critical Care Medicine,Haikou Third People′s Hospital,Haikou 571100,China)

机构地区：[1]海口市第三人民医院呼吸与危重症医学科,海口571100

出　　处：《中国医师杂志》2024年第8期1186-1190,1195,共6页Journal of Chinese Physician

基　　金：海南省医药卫生科研基金项目(21A200156)。

摘　　要：目的探讨人类嗅素结构域家族蛋白4(OLFM-4)、信号肽-CUB-表皮生长因子结构域包含蛋白1(SCUBE-1)联合肝型脂肪酸结合蛋白(L-FABP)对重症肺炎并发急性肾损伤(AKI)的早期诊断价值。方法前瞻性选取2020年1月至2023年5月海口市第三人民医院收治的162例重症肺炎患者,依据其是否发生AKI分为AKI组(54例)和非AKI组(108例)。AKI患者中AKI 1期23例、AKI 2期18例、AKI 3期13例。采用酶联免疫吸附法测定患者入住ICU后12、24、48 h的尿OLFM-4、SCUBE-1及L-FABP水平变化。应用受试者工作特征(ROC)曲线分析不同时间点尿OLFM-4、SCUBE-1及L-FABP水平对重症肺炎患者并发AKI的早期诊断价值。结果AKI组与非AKI组的入住ICU时间、血肌酐、尿素氮、尿酸、血清白蛋白、C反应蛋白、降钙素原、SOFA评分及APACHEⅡ评分比较,差异均有统计学意义(均P<0.05)。在入住ICU后12、24、48 h,AKI组尿OLFM-4、SCUBE-1及L-FABP水平均明显高于非AKI组,差异均有统计学意义(均P<0.001)。AKI 3期患者入住ICU各时间点尿OLFM-4、SCUBE-1及L-FABP水平均明显高于AKI 1期和AKI 2期(均P<0.001),且在24 h时尿OLFM-4、SCUBE-1及L-FABP水平最高。24 h尿OLFM-4、SCUBE-1联合L-FABP诊断重症肺炎并发AKI的AUC最大(AUC=0.964,95%CI:0.908~0.997),其灵敏度为98.2%,特异度为88.3%。Pearson相关分析结果显示,AKI患者尿OLFM-4、SCUBE-1水平与L-FABP均呈正相关(r=0.870,0.775,均P<0.001)。结论尿OLFM-4、SCUBE-1及L-FABP在重症肺炎并发AKI早期显著升高,24 h三项联合检测对AKI的早期诊断具有较高的价值。ObjectiveTo investigate the early diagnostic value of human olfactomedin 4(OLFM-4),signal peptide-CUB-epidermal growth factor-like domain-containing protein 1(SCUBE-1),and liver-type fatty acid binding protein(L-FABP)in severe pneumonia complicated with acute kidney injury(AKI).MethodsA total of 162 patients with severe pneumonia admitted to the Haikou Third People′s Hospital from January 2020 to May 2023 were prospectively selected and divided into an AKI group(54 cases)and a non AKI group(108 cases)based on whether they developed AKI.Among AKI patients,there were 23 cases of AKI stage 1,18 cases of AKI stage 2,and 13 cases of AKI stage 3.Enzyme linked immunosorbent assay was used to measure the changes in urinary OLFM-4,SCUBE-1,and L-FABP levels of patients at 12,24,and 48 h after admission to the intensive care unit(ICU).The receiver operating characteristic(ROC)curve was applied to analyze the early diagnostic value of urinary OLFM4,SCUBE-1,and LFABP levels at different time points for AKI in patients with severe pneumonia.ResultsThere were statistically significant differences in ICU admission time,serum creatinine,urea nitrogen,uric acid,serum albumin,C-reactive protein,procalcitonin,Sequential Organ Failure Assessment(SOFA)score,and Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score between the AKI group and the non AKI group(all P<0.05).At 12,24,and 48 h after admission to the ICU,the urinary OLFM-4,SCUBE-1,and L-FABP levels in the AKI group were significantly higher than those in the non AKI group,and the differences were statistically significant(all P<0.001).The levels of urinary OLFM-4,SCUBE-1,and L-FABP in AKI stage 3 patients were significantly higher than those in AKI stage 1 and AKI stage 2 at all time points after admission to the ICU(all P<0.001),and the highest levels of urinary OLFM-4,SCUBE-1,and L-FABP were observed at the 24 h time point.The combination of 24 h urine OLFM-4 and SCUBE-1 with L-FABP had the highest area under the curve(AUC)for diagnosing severe pneumonia compl

关 键 词：肺炎 急性肾损伤 OLFM4蛋白 SCUBE-1蛋白 肝型脂肪酸结合蛋白 

分 类 号：R563.1[医药卫生—呼吸系统] R692[医药卫生—内科学]