持续性血液滤过治疗危重急性肾损伤患儿尿中性粒细胞明胶酶相关脂质运载蛋白和尿白细胞介素-18联合检测的意义

Clinical research of urine neutrophil gelatinase - associated lipocalin and interleukin - 18 on critically ill patients with acute kidney injury receiving continuous veno -venous hemofiltration

目的 探讨尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）和尿白细胞介素-18（uIL-18）联合检测在判断接受持续性血液滤过（简称血液滤过）治疗的重症急性肾损伤（AKI）患儿病情及预后中的作用。方法 以广州市妇女儿童医疗中心肾内科、PICU和健康体检儿童为观察对象，分为4组：重症接受血液滤过AKI组（A组），重症接受血液滤过非AKI组（B组），重症未接受血液滤过AKI组（C组），健康对照组（D 组）。测定观察对象的血肌酐、uNGAL和 uIL-18水平。结果 A 组、C 组 uNGAL［（161.56 ±71.44）μg/L、（153.69 ±51.33）μg/L］水平较B组、D组［（33.50±10.76）μg/L、（16.37±6.20）μg/L］明显升高（P均 〈0.05），A 组、C组uIL-18［（4.16±1.13）μg/L、（3.81 ±1.05）μg/L］水平较 B 组、D 组［（0.25 ±0.04）μg/L、（0.19 ±0.15）μg/L］明显升高（P均〈0.05）。B、D 组 uNGAL、uIL-18水平组间差异均无统计学意义（P 均 〉0.05）。AKI患儿肾未康复者 uIL-18峰值［（5.15 ±0.78）μg/L比（4.30 ±0.89）μg/L］及 uNGAL峰值［（241.76 ±53.60）μg/L比（196.32±39.28）μg/L］高于肾康复者。危重患儿血液滤过治疗开始时 uNGAL和 uIL-18水平死亡组较存活组明显增高［（213.50 ± 104.78）μg/L 比（79.91 ± 55.81）μg/L，P 〈 0.05］和［（4.48 ±2.32）μg/L比（1.94±1.88）μg/L，P 〈0.05］。危重AKI患儿血液滤过治疗前uNGAL和uIL-18水平死亡组者较存活组明显增高［（256.99±49.33）μg/L比（127.11 ±38.99）μg/L，P 〈0.05］和［（5.48 ±0.67）μg/L比（3.65±0.98）μg/L，P 〈0.05］。AKI患儿 AKI诊断当天 uIL-18和 uNGAL水平死亡组明显高于存活组（P 〈0.05）。结论 血液滤过开始时重症AKI患儿的 uIL-18和 uNGAL水平与其短期预后相关。uIL-18和 uNGAL水平可作为重症AKI患儿的需要肾替代治疗和死亡的预测指标之一。

Objective To explore the effect of urine neutrophil gelatinase -associated lipocalin（uNGAL） and urine interleukin- 18（uIL- 18 ） on the ill condition and prognosis in critically ill patients with acute kidney injury （AKI） at inception of continuous veno -venous hemofiltration（CVVH）. Methods Children came from Department of Nephrology, PICU and heahh examination center in Guangzhou Women and Children＇s Medical Center were divided into 4 groups：critically ill patients with AKI receiving CVVH group （group A） , critically ill patients with non -AKI recei- ving CVVH group（ group B）, critically ill patients with AKI didn＇t recevie CVVH group （group C）, and healthy control group（ group D）. Serum creatinine（SCr） , uNGAL and uIL - 18 in all patients were analyzed. Results The uNGAL in group A and group C[ （ 161.56 ± 71.44） μg/L, （ 153.69 ± 51.33 ） μg/L] increased obviously when compared with group B and group D[ （33.50± 10.76） μg/L, （16.37 ±6.20） μg/Ll （all P 〈0.05 ）. The uIL- 18 in group A and group C [ （4.16 ＋ 1.13 ） μg/L, （3.81 ± 1.05 ） μg/L] was higher than that in group B and group D [ （0.25 ± 0.04 ） μg/L, （0.19 ±0.15） μg/L] （all P 〈0.05）. There was no significance of uNGAL and uIL - 18 between group B and group D（all P 〉 0.05 ）. The peak level of uNGAL [ （241.76 ＋ 53.60） μg/L vs （ 196.32 ± 39.28 ） μg/L 1 and uIL - 18[ （5.15 ±0.78） Ixg/L vs （4.30 ±0.89） μg/L] in critically ill patients with AKI was higher in renal recoveries than in renal non- recoveries（P 〈0.05 ）. The levels of uNGAL and uIL- 18 critically ill patients at initiation of CVVH were higher in non - survivors when compared with survivors[ （213.50 ± 104.78 ） μg/L vs （79.91 ± 55.81 ） μg/L,P 〈 0.05 ], [ （4.48 ± 2.32） μg/L vs （ 1.94 ± 1.88 ） μg/L, P 〈 0.05 ]. The levels of uNGAL and uIL - 18 of critically ill patients with AKI at initiation of CVVH were higher in non - survivors than in survivors [ （ 256.99 ± 49.33） μg/L vs （127.11 ±38.99） μg/L,P〈0.05],[（5.48±0.67） μg/Lvs （3.65 ±0.98） μg/L,P〈0.05]. The levels of uNGAL and uIL - 18 at the first diagnosis time of AKI were higher in non - survivors than in survivors （P 〈 0.05 ）. Conclusions uNGAL and urine IL - 18 at commencement of CVVH predicts short - term prognosis in critically ill patients with AKI. uNGAL and urine IL - 18 can be as a prognostic value in the prediction of the need for renal replacement therapy initiation or mortality in critically ill patients with AKI.