尿中性粒细胞明胶酶相关脂质运载蛋白和肾损伤分子-1预测危重患儿急性肾损伤

Urine neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 in predicting acute kidney injury of critically ill children

目的探讨尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和尿肾损伤分子-1(KIM-1)在预测重症患儿急性肾损伤(AKI)中的意义。方法以慢性肾病(CKD)患儿、重症患儿为研究对象,随机分为重症AKI组(n=27),重症非AKI组(n=30),CKD组(n=30),以健康体检儿童为对照组(n=30),测定比较尿NGAL和KIM-1水平以及其他生化指标。结果重症AKI组的尿NGAL在AKI发生前2天(第–2天)已达峰值,比第–3天的基础值升高超过10倍,并在AKI发生后第2天降至基础值;KIM-1水平在AKI发生前1天(第–1天)升至峰值,比第–3天的基础值升高超过5倍,并保持升高至AKI发生后2 d;NGAL、KIM-1水平随时间变化(–3d^2d)的差异均有统计学意义(P均<0.01)。重症非AKI组、CKD组、对照组的尿NGAL和KIM-1水平随时间变化的差异均无统计学意义(P>0.05)。尿KIM-1、NGAL单独作为标记物诊断AKI时,受试者工作特征曲线(ROC曲线)曲线下面积(AUC)分别为:0.878和0.955(P<0.01),而联合二者诊断AKI时,AUC为0.984(P<0.01)。尿KIM和NGAL升高倍数和CCr谷值呈负相关,Spearman相关系数分别为–0.68和–0.74(P<0.01)。结论联合检测尿NGAL和KIM-1水平可能有助于预测AKI。

Objective To test the predicative roles of neutrophil gelatinase-associated lipocalin （NGAL） and kidney injury molecule-l（ KIM-1 ） for acute kidney injury （AKI） in critically ill patients. Methods Children from pediatric intensive care unit, were randomly divided into four groups： critically ill patients with AKI （group 1 ）, critically ill patients with non- AKI （group 2）, chronic kidney disease group （group 3）, healthy control group （group 4）. 1.5 ml venous blood and urine specimens were collected and kept under -70℃. Serum creatinine, urine NGAL and urine KIM-1 were analyzed. Results Compared with group 2, group 3 and group 4, the urine NGAL and urine KIM-1 increases obviously in group 1 （P〈0.05）. There is no significance of urine NGAL and urine KIM-1 between group2, group3 and group 4 （P〉 0.05）. The concentration of urine NGAL increased more than 10 times of base-line level 2 days before the diagnosis of AKI under the Acute Kidney Injury Network standard with area under curve （AUC） 0.955 （P 〈0.05）, and the concentration of urine KIM-1 increased more than 5 times of base-line level 1 day before AKI with AUC 0.878 （P 〈0.05）. The AUC was 0.984 （P 〈0.01） when they were combined. There is negative correlation between the increased times of urinary KIM-1, urinary NGAL and vally value of creatin clearance rate. Conclusions The concentrations of urine NGAL and urine KIM-1 are useful early biomarkers for predicting AKI, especially when they were combined.