尿肾损伤分子1与白细胞介素18对急性肾损伤患者的诊断价值

Diagnostic value of urinary Kim-1 and IL-1 8 in acute kidney injury

目的：观察尿肾损伤分子1（kidney inj ury molecule-1,Kim-1）与白细胞介素18（inter-leukin-18,IL-18）在急性肾损伤（acute kidney injury,AKI）患者中的变化,探讨其对 AKI的诊断价值。方法选择我院确诊为AKI患者71例（AKI组）,并根据AKI分期,分为AKI 1期组23例、AKI 2期组25例和 AKI 3期组23例；另选择同时期我院体检中心健康体检者30名（健康对照组）,分别检测2组患者尿Kim-1、尿 IL-18及血肌酐（SCr）水平。结果 AKI组 SCr、尿Kim-1较健康对照组明显升高（P〈0.01）,尿 IL-18亦升高（P〈0.05）,与健康对照组比较,SCr、尿 Kim-1在 AKI 1期组、AKI 2期组、AKI 3期组均明显升高（P〈0.01）,尿 IL-18在 AKI 2期组、AKI 3期组亦明显升高（P〈0.01）,在 AKI 1期组虽升高,但差异无统计学意义（P〉0.05）；与 AKI 1期组比较,SCr、尿 Kim-1在 AKI 2期组、AKI 3期组均明显升高（P〈0.01）,尿IL-18在AKI 2期升高（P〈0.05）,在AKI 3期组亦升高（P〈0.01）,与 AKI 2期组比较,SCr、尿 Kim-1及尿 IL-18在 AKI 3期组均明显升高（P〈0.01）；而且相关性分析显示,尿 Kim-1与 SCr 呈正相关（r=0.842,P〈0.01）；尿 IL-18与 SCr 呈正相关（r=0.785,P〈0.01）；尿Kim-1与尿 IL-18呈正相关（r=0.756,P〈0.01）。而 ROC 曲线下面积比较结果显示,尿Kim-1（0.915）明显大于尿 IL-18（0.807）（P〈0.05）。结论尿 Kim-1、尿 IL-18在 AKI患者中升高,二者均可能作为 AKI的诊断标准,且尿Kim-1诊断价值可能更高。

Objective To observe the urinary kidney injury molecule-1 （Kim-1）and interleukin-18 （IL-18）levels and evaluate whether they had diagnostic value in patients with acute kidney injury （AKI）.Methods Seventy-one patients with AKI were selected as the study group （AKI group）,and 30 healthy individuals were enrolled as the control group.The levels of Kim-1 and IL-18,and serum creatinine （SCr）level were determined.Results The urinary Kim-1 ,IL-1 8 and SCr levels were in-creased significantly （P〈0.01 or P〈0.05）in AKI group as compared with control group.The urina-ry Kim-1 and SCr levels were increased significantly （P〈0.01）in AKI stage 1,2 and 3 groups,and the urinary IL-18 increased significantly （P〈0.01）in AKI stage 2 and 3 groups as compared with control group.However,there was no statistically significant difference in the urinary IL-1 8 between AKI stage 1 group and control group.The urinary Kim-1 and SCr levels were increased significantly （P〈0.01）in AKI stage 2 and 3 groups,and the urinary IL-18 increased significantly in AKI stage 2 group （P〈0.05）and AKI stage 3 group （P〈0.01）as compared with AKI stage 1 group.The urina-ry Kim-1,IL-18 and SCr levels were increased significantly （P〈0.01）in AKI stage 3 group as com-pared with AKI stage 2 group.Correlation analysis revealed that the urinary Kim-1 was positively cor-related with SCr and urinary IL-18 （r=0.842,P〈0.01）,the urinary IL-18 was positively correlated with SCr （r=0.785,P〈0.01）,and the urinary Kim-1 was positively correlated with the urinary IL-18 （r=0.756,P〈0.01）.The area under the receiver operating characteristics curve analysis revealed that the urinary Kim-1 （0.915）was greater than the urinary IL-18 （0.807）（P〈0.05）.Conclusions The urinary Kim-1 and IL-1 8 were increased significantly in AKI group.Both of them may be used as diagnostic criteria for AKI,and the diagnostic value of the urinary Kim-1 may be greater.