NGAL、KIM-1和IL-18三者联合检测在儿童急性肾损伤早期诊断中的意义

NGAL, KIM-1 and IL-18 three injury early diagnostic value in children with acute kidney

目的探讨NGAL、KIM-1和IL-18三者联合检测在儿童急性肾损伤（acute kidney injury,AKI）早期诊断中的意义。方法选取2011年6月~2013年6月在我院PICU的100例危重症患儿为研究对象,分为AKI组（40例）与非AKI组（n=60）。收集两组患儿晨起尿液6~8 m L,用酶联免疫吸附法检测尿液中NGAL、IL-18和KIM-1水平,并将三个指标与血清肌酐进行比较,同时绘制ROC曲线,评价尿NGAL、IL-18和KIM-1在AKI早期诊断中价值。结果 AKI组与非AKI组在年龄、性别、收缩压、舒张压、尿比重上无明显差异（P〉0.05）;AKI组与非AKI组比较,Scr、NGAL、KIM-1以及IL-18水平,均显著提高,差异有统计学意义（P〈0.05）;AKI组NGAL、KIM-1、IL-18水平在Scr没有升高之前已经升高,组间差异有统计学意义（P〈0.05）;AKI组患者NGAL在诊断当天曲线下面积0.961（95%CI：0.876~1.000）均好于IL-18与KIM-1 ROC曲线下面积,0.948（95%CI：0.891~1.000）与0.951（95%CI：0.873~1.000）。结论尿中NGAL、KIM-1、IL-18水平在Scr没有升高之前已经显著升高,这为提早诊断儿童急性肾损伤疾病提供了依据,具有重要的临床意义。

Objective To discuss the significance of combined detection of NGAL, KIM-1 and IL-18 three in children with acute kidney injury in the diagnosis of early research. Methods From June 2011 to June 2013 in our hospital, 100 cases of critically ill children with PICU as the research object, and were divided into group AKI （40 cases） and non AKI group （60 cases）. The collection of two groups of children with early morning urine 6-8 ml by enzyme linked im- munosorbent assay（enzyme-linked immunosorbent, assay, ELISA） NGAL detection in urine, IL-18 and KIM-1 levels, and the three indexes and serum creatinine （serum creatinine, Scr） compared, at the same time to draw the ROC curve, evaluation of urinary NGAL, IL-18 and KIM-1 in the AKI value early diagnosis. Results The patients in the AKI group and non AKI group patients in age and sex, systolic blood pressure, diastolic blood pressure, urine specific gravity without obvious difference, and the difference had no statistical significance （P〉0.05）; comparison of patients in the AKI group and non AK! group patients, Scr, NGAL, KIM-1 and IL-18 levels were significantly increased, the difference was statistical significant（P〈0.05）; AKI group of patients with NGAL, KIM-1, IL-18 levels increased be- fore Scr did not rise, there was statistical significance between two groups （P〈0.05）; Patients in group AKI NGAL in the diagnosis of area under the curve （95%CI：0.876-1.000） of the day 0.961 were better than that of IL-18 and KIM- 1ROC area under the curve, 0.948 （95%CI：0.891-1.000） and 0.951 （95%CI：0.873-1.000）. Conclusion The level of NGAL, KIM-I,IL-18 in urine has been increased significantly before Scr does not increase,it is early diagnosis of the disease of acute kidney injury in children and to provide the basis, and has important clinical significance.