脓毒症患者肾损伤程度与肾损伤分子-1表达水平的相关性研究

Relationship between the severity of kidney damage and expression level of kidney injury molecule - 1 in patients with sepsis

目的探讨脓毒症患者。肾损伤程度与尿液肾损伤分子-1（Kim-1）表达水平的相关关系，为脓毒症急性肾损伤（AKI）的早期诊断和预防提供简便、可靠的循证医学依据。方法65例人住ICU的脓毒症患者，根据肾损伤程度，按AKIN诊断和分期标准，分为非AKI组（A组，n=36），轻度AKI组（B组，n=13），中重度AKI组（C组，n=16）。另外选取20例健康体检者作为健康对照组（D组，n=20）。采集患者静脉I衄和尿液，用ELISA法检测尿Kim-1表达水平，酶法测定血肌酐（Scr）水平，并计算肌酐清除率（Ccr），分析Kim-1表达水平与肾损伤程度之间的关系；绘制受试者工作特征曲线（ROC），计算曲线下面积（AUC），评价Kim-1对脓毒症AKI的诊断价值。结果与A组及D组比较，B、C两组尿Kim-1水平均有明显升高（P均〈0．05）；其中C组较B组升高更明显（P〈0．01）；各组Kim—1的表达水平与Ccr水平呈负相关（r=-0．792）；Kim-1的AUC为0．814（P〈0．01）。结论脓毒症AKI患者尿液Kim-1的表达水平较正常人或脓毒症非AKI患者显著增加，其增加幅度与AKI的严重程度呈显著正相关，Kim-1可以作为检测脓毒症AKI的敏感指标。

Objective To examine the relationship between the severity of kidney damage and expression levels of kidney injury molecule - 1 （ Kim - 1 ） in patients with sepsis in order to provide simple and reliable evidence for early diagnosis and prevention in septic patients with acute kidney injury （AKI）. Methods 65 patients with sepsis admitted to ICU were divided into non - AKI group （group A, n=36） , slight AKI group（group B, n=13）, moderate-severe AKI group（group C, n=16） according to different damage degrees and criteria of AKIN for the diagnosis and staging. 20 healthy people were also enrolled as healthy control group （ group D, n = 20）. Patients urine and venous blood were collected, the levels of urinary Kim - 1 were determined by enzyme - linked immunosorbent assay （ELISA） and the levels of serum creatinine （Scr） was measured by enzymes method. The creatinine clearance rate （Ccr） was calculated as well. The relationship between damage degree of kidney and expression level of Kim - 1 was analyzed, receiver operating characteristic curve（ROC） were described and area under the curve （AUC） were calculated. The diagnostic value of Kim - 1 in septic patients with AKI was evaluated. Results Compared with the group A and group D, the urinary Kim- 1 increased obviously in the group B and group C（P 〈0.05） , especially in the group C（P 〈0. 01 ）. Urinary Kim - 1 in each group was negatively correlated with Ccr（ r = -0. 792 ） ; And the Kim - 1 had an AUC - ROC of 0. 8 14 （P 〈0.01 ）. Conclusion Compared with the healthy and the septic patients with non -AKI, the urinary Kim - 1 increases more obviously in septic patients with AKI, and the expression level of increase is significantly positively correlated with the damage degree of kidney, Kim - 1 can be used as a sensitive indicator for the detection of kidney function in sepsis with AKI.