尿肾损伤分子-1在早期诊断急性梗阻性化脓性胆管炎并发急性肾损伤中的应用价值

Application value of urinary kidney injury molecule-1 in the early diagnosis of acute obstructive suppurative cholangitis complicated by acute kidney injury

目的探讨尿肾损伤分子(Kim)-1在早期诊断急性梗阻性化脓性胆管炎(AOSC)并发急性肾损伤(AKI)中的应用价值。方法回顾性分析2006年1月至2012年1月在广东省湛江市中心人民医院肝胆外科接受诊治的66例AOSC患者临床资料。所有患者均签署知情同意书,符合医学伦理学规定。根据入院48 h内是否发生AKI分为AKI组和非AKI组。AKI组21例,其中男9例,女12例;年龄(51±10)岁。非AKI组45例,其中男18例,女27例;年龄(49±9)岁。分别记录与比较两组患者入院时(0 h)及入院后12、24、48 h的尿Kim-1、血清肌酐(Scr)水平。分析尿Kim-1对AKI的诊断价值。两组患者尿Kim-1、Scr水平的比较采用t检验。应用受试者工作特征(ROC)曲线及曲线下面积(A)分析尿Kim-1水平对AKI诊断的灵敏度、特异度。结果 AKI组患者入院时(0 h)尿Kim-1和Scr水平分别为(2.02±0.23)μg/L、(77±17)μmol/L,非AKI组患者相应为(1.89±0.78)μg/L、(72±16)μmol/L,差异无统计学意义(t=1.513,1.742;P>0.05)。入院后12 h,AKI组患者尿Kim-1开始升高,24 h达高峰;非AKI组尿Kim-1入院后12 h也升高并达高峰。AKI组患者入院后12、24、48 h的尿Kim-1水平明显高于非AKI组(t=2.975,5.002,7.614;P<0.05)。入院后48 h,AKI组Scr水平才明显高于非AKI组(t=3.557,P<0.05)。入院后12 h尿Kim-1诊断AOSC合并AKI的A值为0.875,95%可信区间为0.746～0.932。采用Youden指数选择ROC曲线上最佳工作点,诊断的阳性参考值为2.80μg/L,灵敏度为0.90,特异度为0.73。结论尿Kim-1可作为早期诊断AOSC并发AKI的检测指标。

Objective To investigate the application value of urinary kidney injury molecule-1 （Kim-1） in the early diagnosis of acute obstructive suppurative cholangitis （AOSC） complicated by acute kidney injury （AKI）. Methods Clinical data of 66 AOSC patients in Department of Hepatobiliary Surgery, Central People＇s Hospital of Zhanjiang, Guangdong Province from January 2006 to January 2012 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. According to whether AKI occurred within 48 h after admission, the patients were divided into AKI group and non-AKI group. There were 21 patients in AKI group with 9 males and 12 females and mean age of （51±10） years old, and 45 patients in non-AKI group with 18 males and 27 females and mean age of （49±9） years old. The levels of urinary Kim-1 and serum creatinine （Scr） at the time of admission （0 h） and 12, 24, 48 h after admission were recorded and compared between two groups. The value of urinary Kim-1 in the diagnosis of AKI was analyzed. The levels of urinary Kim-1 and Scr in two groups were compared using t test. The sensitivity and specificity of urinary Kim-1 in the diagnosis of AKI were analyzed using receiver operating characteristic （ROC） curve and area under curve （A）. Results The levels of urinary Kim-1 and Scr of patients in AKI group and non-AKI group at the time of admission （0 h） were （2.02±0.23）μg/L, （77±17）μmol/L and （1.89±0.78）μg/L, （72±16）μmol/L respectively. There was no significant difference between two groups （t=1.513, 1.742; P〉0.05）. The level of urinary Kim-1 of patients in AKI group began to rise at 12 h after admission and peaked at 24 h after admission, while it rose and peaked at 12 h after admission in non-AKI group. The levels of urinary Kim-1 of patients in AKI group at 12, 24, 48 h after admission were evidently higher than that in non-AKI group （t=2.975, 5.002, 7.614; P〈0.05）. The level of Scr of patients in AKI group was evidently higher than that in non-AKI group only at 48 h after admission （t=3.557, P〈0.05）. The A value of urinary Kim-1 in the diagnosis of AOSC complicated by AKI at 12 h after admission was 0.875 with the 95% confidence interval of 0.746-0.932. The best operating point on the ROC curve was defined using Youden index and the positive reference value was 2.80 μg/L, the sensitivity was 0.90, the specificity was 0.73. Conclusion Urinary Kim-1 can be a parameter in the early diagnosis of AOSC complicated by AKI.