尿Sema3A对重症监护病房患者急性肾损伤的早期诊断价值

The early diagnostic value of urinary Sema3A for ICU adult patients with acute kidney injury

目的 探讨信号素3A （Sema3A）对成人重症监护病房急性肾损伤（AKI）的早期诊断价值及其与脓毒症的关系.方法 以中南大学湘雅医院重症医学科（ICU） 2013年7至12月预期入住ICU时间＞24 h入ICU时未发生AKI年龄＞18岁的患者为研究对象.记录患者一般临床资料,并每12 h收集血清、尿标本,用酶联免疫法检测尿Sema3A和中性粒细胞明胶酶相关脂质运载蛋白（NGAL）.根据是否发生AKI分为AKI组和非AKI组,根据引起AKI的原因是否为脓毒症分为AKI脓毒症组、AKI非脓毒症组、非AKI脓毒症组、非AKI非脓毒症组.AKI组选取诊断AKI当时及前24h的标本,诊断AKI当时计为T（0）h,前面两个时间点分别计为T（-12）h、T（-24）h.非AKI组取入室后前3个时间点的标本,分别计为T（0）h、T（-12）h、T（-24）h.整理资料进行统计学分析.结果 AKI组尿Sema3A、尿NGAL较非AKI组高（P＜0.05）.AKI组尿Sema3A、尿NGAL浓度随时间变化有增高趋势,其中T（-24）h、T（-12）h分别与T（0）h比较差异有统计学意义.T（-24）h尿Sema3A、尿NGAL分别与血肌酐、APACHEⅡ呈正相关性.尿Sema3A以T（-12）h的AUC最大为0.885（95％ CI 0.774 -0.997,P＜0.05）;尿NGAL以T（-24）h的AUC最大为0.878（95％ CI 0.788-0.993,P＜0.05）.脓毒症组与非脓毒症组Sema3A差异无统计学意义,而两组间NGAL差异有统计学意义.S-AKI组与非S-AKI组尿Sema3A差异无统计学意义,而两组之间的尿NGAL差异有统计学意义.尿Sema3A死亡组较生存组高（P＜0.05））.结论 尿中Sema3A检测有助于AKI的早期诊断;尿中Sema3A浓度不受脓毒症影响,更有预测价值.

Objective To research the early diagnosis value of Semaphorin3A as a biaomarker on acute kidney injury（AKI） in adult intensive care unit（ICU）,and explore the relationship between Sema3A and sepsis.Methods The objects of the study are patients who were enrolled from July 2013 to December 2013 in XiangYa Hospital ICU.After admission and study enrollment,clinical data were recorded,and every 12 h serum,urinary samples were collected for Sema3A and neutrophil gelatinase associated lipocalin （NGAL） detected by enzyme linked immunosorbent assay（ELISA）.According to the development of AKI,patients were divided into AKI group and non-AKI group.According to whether the AKI induced by sepsis,patients were divided into AKI-sepsis group,AKI-non-sepsis group,non-AKI-sepsis-group,non-AKI-and-non-sepsis group.The samples were selected in AKI group when AKI was diagnosed and 24 h before,the time when AKI diagnosed was counted asT（0）h,the other times were counted as T （-12） h,T （-24） h.In non-AKI group,the samples of the first three time points after admission were selected,and counted as T （0） h,T （-12） h,T （-24） h,respectively.Date was collected for statistical analysis.Results Compared with non-AKI group,AKI urinary Sema3A,urinary NGAL is higher,and the difference was statistically significant.In group AKI urinary Sema3A,urinary NGAL concentration change over time and there is an increasing trend,where the T （-24） h and T（0）h,T （-12） h and T （0） h respective comparison,the difference was statistically significant.Correlation Analysis：T （-24） h urinary Sema3A and urinary NGAL were positively correlated with serum creatinine,APACHE Ⅱ.The AUC of urinary Sema3A with T （-12） h had the largest area of 0.885 （95% CI 0.774-0.997,P 〈 0.05）;the AUC of urinary NGAL with T （-24） h had the largest area of 0.878 （95% CI 0.788-0.993,P 〈 0.05）.There was no significant difference between sepsis group and non-sepsis group Sema3A,but there is significant difference between the two groups NGAL.There was no significant difference between S-AKI group and non-S-AKI group urinary Sema3A,but urinary NGAL were significantly different between the two groups.Compared with survival group,urinary Sema3A of death group was higher,and the difference was statistically significant.Conclusion Urinary Sema3A can help early diagnose of adult AKI.Compared to urinary NGAL,the concentration of urinary Sema3A was not affected by sepsis,and will be more useful for prediction.