尿L-FABP在预测急性肾损伤预后中的意义

Urinary liver-type fatty acid-binding protein as a prognostic biomarker in patients with acute kidney injury

目的 观察住院急性肾损伤（AKI）患者尿肝脏型脂肪酸结合蛋白（L-FABP）的水平,分析其对肾脏替代治疗（RRT）及住院死亡的预测能力.方法 前瞻性收集经肾内科医师会诊确诊AKI患者103例,留取会诊时患者的血尿标本,检测其血尿肌酐及尿L-FABP水平.运用ROC曲线评估尿L-FABP预测AKI患者预后的准确性.结果 ①103例患者中,50例接受了RRT（48.5％）,45例住院期间死亡（42.7％）;②尿L-FABP可以预测行机械通气及合并脓毒症AKI患者是否需要进行RRT,AUC分别为0.822和0.743（P ＜0.001）;③尿L-FABP可以预测AKI患者住院病死率,当截断值为124.95 ng/mg·Cr,敏感性和特异性均较高.对未发生心衰、行机械通气、AKIN-2和3期的AKI患者,尿L-FABP预测其住院期间死亡准确性好,AUC分别为0.844、0.832、0.912和0.900（P ＜0.05）.校正了年龄、性别、急性肾衰预后评分（ATN-ISS）后,尿L-FABP高于均值组的患者发生住院期间死亡的风险比低于均值组高1.24倍（HR 2.24,95％CI 1.50～3.09,P=0.02）.结论 住院患者中AKI的发生率及死亡率高.尿L-FABP可以预测行机械通气、合并脓毒症的AKI患者是否需要RRT,以及AKI患者住院期间死亡率.

Objective To observe the levels of urinary liver-type fatty acid-binding protein （L-FABP） in the in-hospital patients with acute kidney injury （AKI）,and examine the performance of L-FABP for predicting renal replacement therapy （RRT） or in-hospital death.Methods This prospective cohort study contained 103 patients with an established diagnosis of AKI.The levels of serum creatinine,urine creatinine and urinary L-FABP were obtained at time of nephrology consultation.Receiver-operating characteristic curves were generated to explore the diagnostic performance of urinary L-FABP for predicting the outcomes of patients with AKI.Results ①Of 103 patients,50cases were under RRT （48.5％）,45 cases died in hospital （42.7％）.②L-FABP displayed better discrimination for prediction of RRT in patients with mechanical ventilation （AUC 0.822） and sepsis （AUC 0.743,P ＜ 0.001）.③ Urinary L-FABP performed well for prediction of in-hospital death,and sensitivity and specificity were high for a cut-off value of 124.95 ng/mg · Cr.L-FABP displayed better discrimination for prediction of in-hospital death in patients without heart failure （AUC 0.844）,patients with mechanical ventilation （AUC 0.832）,patients with stage-2 （AUC 0.912） and stage-3AKI （AUC 0.900,P ＜ 0.05）.After adjusted for age,gender and ATN-ISS,patients with urinary L-FABP above average would have a 1.24-fold higher probability of in-hospital death than those with urinary L-FABP below average （HR2.24,95％CI 1.50～3.09,P=0.02）.Conclusion AKI is associated with increased morbidity and mortality in hospitalized patients.Urinary L-FABP performed well at predicting dialysis requirement for patients with mechanical ventilation and sepsis,and predicting in-hospital mortality for patients with AKI.