尿中性粒细胞明胶酶相关脂质运载蛋白和白细胞介素-18对重症患者急性肾损伤的早期诊断价值

Urinary neutrophil gelatinase-associated lipocalin and urinary interleukin-18 in early diagnosis of acute kidney injury in critically ill patients

目的 探讨尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）和尿IL-18（uIL-18）对重症患者急性肾损伤（AKI）的早期诊断价值.方法 以我院ICU收治的92例危重症患者为观察对象,将1周内符合RIFLE诊断标准的AKI患者纳入AKI组（46例）,对照组（46例）由匹配的非AKI患者构成.每日收集尿标本,持续1周.ELISA检测uNGAL和uIL-18水平.用受试者工作特征曲线（ROC）评价uNGAL、uIL-18和血肌酐（SCr）对AKI的诊断作用.结果 与AKI诊断前3天比较,AKI诊断前2天患者uNGAL明显增高（P〈0.05）,但uIL-18和SCr无明显改变（P值均〉0.05）;AKI诊断前1天AKI患者uNGAL和uIL-18明显增高（P值均〈0.05）,但SCr无明显改变（P〉0.05）;观察期间对照组uNGAL、uIL-18和SCr均无明显变化（P值均〉0.05）.AKI诊断前3天uNGAL、uIL-18和SCr对AKI均无诊断作用;AKI诊断前2天uNGAL的ROC曲线下面积为0.840（95%CI 0.672～1.009,P〈0.05）,对AKI具有诊断作用,而uIL-18和SCr均无诊断作用;AKI诊断前1天uNGAL和uIL-18的ROC曲线下面积分别为0.830（95%CI 0.711～0.950,P〈0.05）和0.818（95%CI 0.697～0.938,P〈0.05）,对AKI具有诊断作用,而SCr无诊断作用.结论 uNGAL和uIL-18对重症患者AKI可能具有早期诊断价值.

Objective To determine whether urinary neutrophil gelatinase-associated tipocalin （uNGAI,） and urinary interleukin-18 （ulL-18） are early markers of acute kidney injury （AKI） in critically ill patients. Methods Ninety-two critically ill patients were studied for one week after their enrollment into our hospital. During the study, 46 patients who met the RIFLE criteria were selected as AKI group and the remaining 46 patients without AKI taken as a control group. The two groups were matched for age, gender and illness severity. Urine samples were collected daily for one week. The receiver operating characteristic curve was used to evaluate the early diagnostic value of uNGAL, ulL-18 and serum creatinine （SCr）. Results As compared with the levels obtained 3 days before the diagnosis of AKI, the uNGAL levels in the AKI group increased significantly （P 〈 0. 05 ）, while nIL-18 and SCr levels did not change 2 days prior to the diagnosis of AKI （ all P 〉 0. 05 ）. uNGAL and uIL-18 levels increased significantly （ all P 〈 0. 05） ,while SCr levels did not change 1 day prior to the diagnosis of AKI in the AKI group （P 〉0. 05）. The levels of uNGAL, ulL-18 and SCr did not change significantly in the control group during the study period （ all P 〉 0. 05）. Three days before the diagnosis of AKI, concentrations of uNGAL, nIL-18 and SCr were not the predictive of AKI. Two days before the diagnosis of AKI, the area under the curve （AUC） of uNGAI, was 0. 840 （95% CI 0. 672-1. 009, P 〈 0. 05 ）, which indicated that uNGAL was the predictive of AKI while uIL-18 and SCr were not. One day before the diagnosis of AKI, the AUC of uNGAL and uIL-18 were 0. 830 （95% C10. 711-0. 950, P 〈 0. 05 ） and 0. 818 （95% C10. 697-0. 938, P 〈 0. 05 ）, indicating that uNGA1,and uIL-18 were the predictive of AKI while SCr was not. Conclusion uNGAL and ulL-18 may be the early predictive markers of AKI in critically ill patients.