尿肾损伤分子1和肝型脂肪酸结合蛋白水平对脓毒症急性肾损伤的预测价值

Predictive value of urine concentration of KIM-1 and L-FABP for acute renal injury in sepsis patients

目的:探讨尿中肾损伤分子1(KIM-1)和肝型脂肪酸结合蛋白(L-FABP)水平对脓毒症急性肾损伤(AKI)的预测价值。方法:收集117例脓毒症患者的临床资料,按照是否发生AKI分为脓毒症非AKI组(76例)和脓毒症AKI组(41例)。采用ELISA法检测尿KIM-1及L-FABP水平,运用受试者工作特征(ROC)曲线及曲线下面积(AUC),评估尿KIM-1、L-FABP水平及单独或联合检测对脓毒症AKI的预测价值。结果:与脓毒症非AKI组比较,脓毒症AKI患者尿KIM-1水平在-24、0、24、48 h时间点显著升高(均P <0. 05)。脓毒症患者发生AKI前24 h,将其尿KIM-1、L-FABP水平单独或联合检测的ROC曲线进行分析,AUC分别为0. 792、0. 781和0. 818(均P <0. 05)。当取KIM-1截断值为21. 00 ng/L时,敏感性为0. 8780,特异性为0. 6447。当取L-FABP截断值为14. 00 ng/L时,敏感性为0. 7317,特异性为0. 7368。建立KIM-1联合L-FABP检测的预测模型,取截断值为0. 2239时,敏感性为0. 8780,特异性为0. 6711。结论:脓毒症发生AKI前24 h检测患者尿KIM-1及L-FABP水平,有助于预测脓毒症AKI的发生,联合检测价值较单独检测更大。

Objective: To evaluate the prognostic value of urine concentration of kidney injury molecule-1( KIM-1) and liver-type fatty acid binding protein( L-FABP) in sepsis-induced acute renal injury( AKI). Methods: Clinical data of 117 sepsis patients were collected,and according to the occurrence of AKI,they were divided into non-AKI group( 76 cases) and AKI group( 41 cases). Urine concentration of KIM-1 and L-FABP were analyzed by enzyme linked immune sorbent assay( ELISA). The changes of urine KIM-1 and L-FABP concentration and their predictive value for sepsis-induced AKI were evaluated by receiver operating characteristic( ROC) curve and area under curve( AUC). Results: The urine KIM-1 concentration in sepsis patients with AKI was significantly higher at-24 h,0,24 h and 48 h than that in non-AKI group( all P < 0. 05).The ROC curves of KIM-1,L-FABP at-24 h before the onset of AKI in sepsis patients and their combined detection were analyzed. The results showed that AUC was 0. 792,0. 781 and 0. 818,respectively( P < 0. 05). When KIM-1 cut-off > 21. 00 ng/L was taken,the sensitivity and specificity were 0. 8780 and 0. 6447 respectively. When L-FABP cut-off > 14. 00 ng/L,the sensitivity and specificity were 0. 7317 and 0. 7368 respectively. The prediction model of KIM-1 combined with L-FABP was established. When cut-off > 0. 2239,the sensitivity and specificity were 0. 8780 and 0. 6711 respectively. Conclusion: Urine KIM-1 and L-FABP can be detected 24 h before the onset of AKI in sepsis,which is helpful for the prediction of AKI in sepsis.Combined detection is more valuable than single detection.