尿肾损伤分子-1检测对伽玛刀治疗过程中肿瘤患者发生急性肾损伤的早期诊断

Expression of Urine Kidney Injury Molecule-1 of Tumor Patients Predicts Acute Kidney Injury During Gama-Ray Stereotactic Radiosurgery

目的:近年来接受立体定向伽玛射线治疗系统(伽玛刀)治疗的肿瘤患者日益增多,我们观察到部分患者在治疗过程中并发急性肾损伤(AKI),而肿瘤患者并发AKI后病死率明显增加,因此如何早期诊断和早期干预是防治和逆转疾病进展的关键。本研究旨在观察伽玛刀治疗过程中发生AKI的肿瘤患者尿肾损伤分子-1(KIM-1)表达水平的变化及其对AKI的早期诊断价值。方法:收集我院2007年5月～2007年11月期间于伽玛刀中心入院接受体部伽玛刀治疗的100例患者的详细资料,以伽玛刀治疗过程中血清肌酐上升超过0.3mg/dl或较基础值上升>50%为AKI的诊断标准。ELISA方法检测伽玛刀治疗过程中(造影12h、24h、48h、伽玛刀治疗7次、伽玛刀治疗结束)肿瘤患者尿KIM-1表达水平的变化。结果:所有肿瘤患者中,25例为AKI组,75例为非AKI组。在造影12h、24h、48h和伽玛刀治疗7次各时间点,AKI组尿KIM-1水平均显著高于无AKI组(P值均<0.05)。在造影48h和治疗结束时,AKI组血肌酐水平显著高于无AKI组(P<0.05),而其他时间点差异无统计学意义(P>0.05)。经尿肌酐校正后,在造影12h、24h、48h,AKI组患者尿KIM-1/尿肌酐表达水平显著高于非AKI组(P值均<0.05),而其他时间点差异无统计学意义(P>0.05)。以造影12h尿KIM-1/尿肌酐表达水平诊断AKI的灵敏度和特异度绘制ROC曲线,其AUC为0.709(95%CI为0.585～0.832,P<0.05),与完全随机情况下获得的AUC=0.5的差异有统计学意义(P<0.05)。结论:肿瘤患者在伽玛刀治疗过程中,造影后12h监测尿KIM-1表达水平可以较血肌酐更早期预测急性肾损伤的发生,及时检测有利于早期干预和治疗。

Objective： To assess whether urine kidney injury molecule- 1 （KIM- 1 ） could predict acute kidney injury in the tumor patients treated with gama - ray stereotactic radiosurgery （Gama knife）. Methods： 100 tumor patients admitted to our hospital from May 2007 to Nov 2007 were treated with Gama knife radiotherapy. AKI was defined as the absolute increment over 0.3 mg/dl from baseline or 50% increase in serum creatinine according to the RIFLE criteria. All these patients used the low - os- molar nonionic contrast medium before treated with Gama knife. The clinical features of all patients were observed. Urine KIM - 1 was measured by ELISA. Receiver operating characteristic curve （ROC）and area under the curve （AUC） were described. Results： Of all patients, acute kidney injury group included 25 patients and no acute kidney injury group included 75 patients. The urinary KIM- 1 levels in AKI group were significantly higher at 12 h,24 h,48 h after intravenous injection of contrast medium and 7d after treated with Gama knife compared with no AKI group. The urine KIM - 1 values were also significantly different between AKI group and no AKI group at 12 h,24 h,48 h after intravenous injection of contrast medium when normalized to urinary creatinine concentration. On diagnostic performance testing, urine KIM- 1/urinary ereatinine value demonstrates an area under the receiver operating characteristic curve of 0. 709 （95 % CI 0. 585 - 0. 832, P 〈 0.05） to predict AKI at the time point of 12h after contrast injection. Conclusion： Urine KIM - 1 measurement may predict onset of acute kidney injury in the tumor patients treated with Gama knife. It is a relatively more sensitive early biomarkers than serum creatinine in tumor patients.