ICU患者急性肾损伤的早期诊断标志物初探

Early Diagnostic Markers of Acute Kidney Injury in ICU Patients

目的探讨ICU患者急性肾损伤（AKI）的早期诊断标志物。方法选择2010年1月—2012年6月入住英山县人民医院ICU的156例患者作为研究对象,其中AKI 69例,非AKI 87例。检测患者血液和尿液中标志物。结果 AKI组血肌酐、血清胱抑素C水平均高于非AKI组,差异有统计学意义（P〈0.05）;AKI组中Ⅱ期、Ⅲ期患者血肌酐水平高于非AKI组,差异有统计学意义（P〈0.05）;AKI组中Ⅰ期、Ⅱ期、Ⅲ期患者血清胱抑素C水平高于非AKI组,差异有统计学意义（P〈0.05）。AKI组尿人中性粒细胞明胶酶相关脂质运载蛋白（NGAL）水平高于非AKI组,差异有统计学意义（P〈0.05）;AKI组中Ⅰ期、Ⅱ期、Ⅲ期患者尿NGAL水平高于非AKI组,差异有统计学意义（P〈0.05）。AKI组血清胱抑素C水平在24h内和24~48h内高于非AKI组,差异有统计学意义（P〈0.05）;AKI组血清胱抑素C水平在48h后水平与非AKI组比较,差异无统计学意义（P〉0.05）。结论血清胱抑素C水平和尿NGAL水平对诊断早期AKI的灵敏度和特异度较高,有助于ICU患者AKI的早期诊断及危险分层,为临床分期提供依据,指导治疗。

Objective To investigate the early diagnostic markers of severe acute kidney injury（ AKI） in ICU patients. Methods A total of 156 ICU patients were selected in the People＇ s Hospital in Yingshan County from January 2010 to June 2012,they were divided into groups A（ with AKI,n = 69） and B（ without AKI,n = 87） according to incidence of AKI. Biomarkers in blood and urine were detected. Results Serum creatinine,cystation C levels of A group were higher than those of B group（ P 〈0. 05）,and serum creatinine level of patients staging at Ⅱ,Ⅲ of A group was higher than that of B group,respectively（ P〈 0. 05）,and serum cystation C level of patients staging at Ⅰ,Ⅱ,Ⅲ of A group was higher than that of B group,respectively（ P 〈0. 05）. Urine NGAL level of A group were higher than that of B group（ P 〈0. 05）,and urine NGAL level of patients staging atⅠ,Ⅱ,Ⅲ of A group was higher than that of B group,respectively（ P 〈0. 05）. Serum cystation C level and urine NGAL level within 24 h and 24 - 48 h of A group were higher than those of B group（ P 〈0. 05）,but no significant differences was found of serum cystation C level and urine NGAL level between the two groups after 48h（ P 〉0. 05）.Conclusion Serum cystation C level and urine NGAL level has higher sensitivity and specificity in early diagnosing AKI in ICU patients,is helpful to risk stratification,clinical staging and guiding therapy.