胰岛素样生长因子-1测定对ICU急性肾损伤患者的临床意义

Clinical Significance of the Serum Insulin-like Growth Factor-1 Level in Patients with Acute Kidney Injury in Intensive Care Unit

目的探讨胰岛素样生长因子-1(IGF-1)测定对ICU急性肾损伤(AKI)患者的临床意义。方法前瞻性研究2008-01-01—2010-01-01入住ICU的AKI患者,根据合并其他脏器功能衰竭情况,分为AKI未合并或仅合并一个其他器官功能衰竭组(AKI-1组)和AKI合并两个及两个以上器官功能衰竭组(AKI-2组),另设正常对照组。测定各组患者血清游离IGF-1水平,分析IGF-1与AKI患者改良定量主观整体评估(MQSGA)、血胆固醇水平及近期病死率的关系。结果 IGF-1水平:AKI-1、AKI-2组均明显低于正常对照组(P<0.05),其中AKI-2组较AKI-1组血清游离IGF-1水平明显下降(P<0.05);血清IGF-1水平与胆固醇水平呈正相关(r=0.643,P<0.05);AKI各组中存活患者较死亡患者IGF-1水平显著增高(P<0.05)。结论血清游离IGF-1可以反映ICUAKI患者的营养状态,IGF-1水平越低,提示营养状况越差;血清游离IGF-1水平可以反映AKI病情的危重程度,并随受累器官衰竭的增加而下降加剧;血清游离IGF-1水平明显下降可能是AKI患者预后不良的危险信号。

Objective To assess the clinical significance of insulin-like growth factor-1（IGF-1） as an indicator of patients with acute kidney injury（AKI） in intensive care unit（ICU）.Methods A prospective cohort study was designed to investigate the relationship between serum IGF-1 and Subjective Global Assessment（SGA） score,serum cholesterol level and near-term mortality in patients with AKI in ICU from January 2008 to January 2010.All 120 patients were divided into group AKI-1（32 patients） and group AKI-2（88 patients） according to the severity of viscera injury.In addition,20 healthy subjects were internalized as control group.Results The serum IGF-1 levels in both AKI-1 and AKI-2 groups were significantly lower than that of healthy control（P〈0.05）.Compared with AKI-1 group,the serums IGF-1 of AKI-2 were significantly declined（P〈0.05）.The serums IGF-1 was positive correlated with cholesterol levels（r=0.643,P〈0.05）.The serum IGF-1 level was also significantly higher in the survival patients than the dead ones.Conclusion Serum free IGF-1 can reflect the nutrition status of patients with acute renal injuries in ICU.Lower IGF-1 level indicates poor nutritional status.In addition,serum free IGF-1 level can refelect the severity of AKI,which can be exaggerated along with the increased number of the involved organs.The significant decrease of serum free IGF-1 is a dangerous signal of poor prognosis of AKI.