sTREM-1和NGAL对脓毒血症并发急性肾损伤早期诊断的预测价值

Prediction of acute kidney injury complicated by sepsis with sTREM-1 and NGAL as early marker

目的探讨尿可溶性髓系细胞表达的触发受体1（sTREM－1）、尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）对脓毒血症并发急性。肾损伤（AKI）的早期诊断价值。方法前瞻性纳入无锡市人民医院ICU收治的脓毒血症患者141例。收集确诊脓毒血症后不同时间点的血、尿标本，检测患者血肌酐、尿sTREM－1和尿NGAL水平。根据是否并发AKI，将患者分为AKI组和非AKI组，观察两组Scr、尿sTREM－1和尿NGAL的动态变化。酶法检测Scr，酶联免疫吸附法测定血sTREM－1、尿sTREM－1和尿NGAL水平。用受试者工作特征曲线（ROC）评价尿sTREM－1和NGAL对AKI的诊断价值。结果44例脓毒血症患者并发AKI（31．2％）。AKI组Scr于脓毒血症确诊后24h上升至基线值的1．91倍[（140．5±13．6）比（82．6±15．3）μmol／L，P〈0．05]。AKI组患者尿sTREM－1和尿NGAL在脓毒血症确诊后8h开始升高[（100．5±17．4）比（38．9±14．7）ng／L；（144．6±51．9）比（56．2±43．8）μg／L，均P〈0．05]，且随后的各时间点均高于基线值（均P〈0．05），也高于非AKI组（均P〈0．05）。脓毒血症确诊后8h，尿sTREM-1诊断AKI的ROC曲线下面积为0．877，95％CI（0．756～0．914），以70ng/L作为诊断AKI的截取值时，其敏感性和特异性分别为89．1％和82．0％；尿NGAL预测AKI的ROC曲线下面积为0．862，95％CI（0．703～0．958），以90μg／L作为诊断AKI的截取值时，其敏感性和特异性分别为87．4％和85．5％。结论脓毒血症确诊8h后尿sTREM-1和NGAL水平对AKI具有预测价值，其诊断时间早于Scr。尿sTREM。1和NGAL可作为脓毒血症并发AKI患者的早期诊断的标志物。

Objective To determine whether triggering receptor expressed on myeloid cells- 1 （sTREM- 1） and urinary neutrophil gelatinase- associated lipocalin （NGAL） were early biomarkers of acute kidney injury （AKI） secondary to sepsis. Methods A total of 141 eligible patients were enrolled in this prospective study. Blood and urine samples were collected at different time points as soon as sepsis was diagnosed. The concentrations of serum creatinine （Scr）, urine sTREM- 1 and NGAL were measured. According to AKI criteria, patients were divided into the AKI group and non- AKI group. Dynamic changes of levels of Scr, urine sTREM- 1 and NGAL were observed in two groups. The receiver operating characteristic curves were used to evaluate the early diagnostic value of urine sTREM-1 and NGAL. Results Among 141 septic patients, 44 （31.2%） cases had concomitant AKI. Twenty four hours after sepsis diagnosed, the level of Scr rose to 1.91 times of the baseline [（140.5±13.6） vs （82.6± 15.3） μmol/L, P 〈 0.05], which met the diagnostic criteria of AKI. In the AKI group, urinary concentrations of sTREM - 1 and NGAL at 8 h after the diagnosis of sepsis began to rise significantly from baseline [（100.5±17.4） vs （38.9±14.7） ng/L; （144.6±51.9） vs （56.2±43.8） μg/L, both P 〈 0.05].And at the following time points, urinary concentrations of sTREM- 1 and NGAL were significantly higher than the baseline levels and that of the non- AKI group （all P 〈 0.05）. At 8 h time point, the area under the curve of urine sTREM-1 was 0.877 （95%CI 0.756-0.914）, the sensitivity was 89.1% and specificity was 82.0% with a cutoff value of 70 ng/L. At 8 h time point, the area under the curve of urine NGAL was 0.862 （95% CI 0.703-0.958）, the sensitivity was 87.4% and specificity was 85.5% with a cutoff value of 90 μg/L. Conclusions Urinary concentrations of sTREM- 1 and NGAL at 8 h time point after the diagnosis of sepsis have predictive value for AKI and their diagnostic time is much earlier than that of Ser. Therefore, urinary sTREM- 1 and NGAL can be used as early biomarkers of set）tic AKI.