尿肝型脂肪酸结合蛋白和尿中性粒细胞明胶酶相关脂质运载蛋白用于诊断严重脓毒症患者急性肾损伤

Diagnostic value of urinary liver-type fatty acid binding proteins and urinary neutrophil gelatinase-associated lipocalin in severe sepsis patients with acute kidney injury

目的探讨尿肝型脂肪酸结合蛋白(uL-FABP)及其与尿中性粒细胞明胶酶相关脂质运载蛋白(uNGAL)在判断严重脓毒症患者是否发生急性肾损伤(AKI)及评估AKI严重程度中的价值,以期能为AKI的早期诊断提供方便可靠的方法。方法前瞻性收集严重脓毒症和脓毒症休克患者入院时、入院后12小时、24小时、48小时和72小时的尿标本,分别检测血清肌酐(SCr)、uL-FABP和u-NGAL水平,比较AKI和非AKI患者各标志物的动态变化情况。运用受试者工作特征(ROC)曲线及曲线下面积(AUC),评估标志物单独及联合应用时诊断AKI的准确性。结果总共60例患者中26例(43.3%)发生了AKI,与非AKI患者相比较,AKI患者的uL-FABP和u-NGAL水平显著升高。uL-FABP和u-NGAL水平在AKI组入院后12小时即显著高于非AKI组,其浓度变化明显早于SCr。在入院后12小时,uL-FA BP和u-NGAL的AUC分别为0.901和0.906,在界值分别为985μg/g·Cr和52μg/g·Cr时,uL-FABP和u-NGAL的敏感度和特异度分别为85.2%和84.6%以及87.8%和86.5%。结论uL-FABP和uNGAL在严重脓毒症患者AKI早期即显著升高,比SCr能更早地预测AKI的发生和严重程度,两者联合应用则可使诊断的精确性进一步提高。

Objective To investigate the early diagnosis value of urinary liver-type fatty acid binding proteins （uL-FABP）and urinary neutrophil gelatinase-associated lipocalin（u-NGAL）in severe sepsis patients with acute kidney injury（AKI）.Methods Sixty patients with severe sepsis and sepsis shock patients were enrolled in this study.After admission,urinary samples were collected for detection of the levels of serum creatinine（SCr）,uL-FABP and u-NGAL at 12 h,24 h,48 h and 72 h.According to the RIFLE criteria for diagnosis of AKI,all patients were classified as AKI group （26 cases）or non-AKI （34 cases）.Serum creatinine,u-NGAL and uL-FABP of the patients were analyzed daily. The differences of uL-FABP,u-NGAL and serum creatinine between AKI and non-AKI patients were compared. Sensitivity and specificity of uL-FABP,u-NGAL and serum creatinine for diagnosis of AKI were evaluated using receiver operating characteristic（ROC）curve.Results The levels of uL-FABP and u-NGAL were significantly different between AKI and non-AKI patients in the first 12 h,while there was no significant difference in SCr between groups. The area under ROC curve of uL-FABP and u-NGAL in AKI patients in the first 12 h were 0.901 and 0.906, respectively.The cutoff values of uL-FABP and u-NGAL were 985 μg/g· Cr and 52 μg/g· Cr,respectively.And sensitivity and specificity of uL-FABP were 85.2% and 84.6%,respectively,and those of u-NGALwere 87.8% and 86.5%,respectively.Conclusion uL-FABP and u-NGAL may be superior to SCr in diagnosis of AKI,and could be used as markers for the early diagnosis of AKI.