儿童急性肾损伤及早期生物标记物的临床评价

Clinical evaluation on pediatric acute renal injury and early biomarkers

目的分析儿童急性肾损伤的临床特征,探讨生物标记物对儿童AKI的诊断价值。方法选取2016年6月~2017年3月在我院儿科和中南大学湘雅二医院儿童医学中心肾内科住院的患儿60例作为研究对象,按照AKIN标准分为AKI组(30例)和非AKI组(30例),选取同期同年龄段健康体健儿童24例作为对照组。分析AKI患儿临床特征及影响因素,观察不同组患儿尿及血清中生物标记物水平,比较不同生物标记物对AKI的诊断价值。结果引起AKI的常见疾病分别为脓毒症、药物中毒、重症过敏性紫癜和蛇咬伤。身高和体重与AKI发生有较高的相关性(P<0.05)。入院后2 h,除SCr外,两组患儿的尿KIM-1、NGAL、L-FABPs、血清Cys C及NGAL水平比较,差异均有统计学意义(P<0.01)。入院后48 h,两组患儿的SCr水平比较,差异有统计学意义(P<0.01);AKI组其他各项指标水平较之前下降,但仍高于非AKI组,差异均有统计学意义(P<0.01)。入院2 h,尿KIM-1、NGAL、L-FABP、血清Cys C、NGAL及SCr诊断AKI的AUC分别为0.912、0.922、0.909、0.906、0.943和0.533。入院48 h,尿KIM-1、NGAL、L-FABP、血清Cys C、NGAL及SCr诊断AKI的AUC分别为0.887、0.904、0.858、0.818、0.889和0.942。结论AKI与疾病严重程度有关。在肾脏病变的情况下,身高和体重可能是AKI发生的影响因素。血NGAL对AKI的早期临床诊断可能具有较好的参考价值,SCr仍不失为预测AKI的一项重要指标。

Obiective To analyze the clinical features of pediatric acute kidney injury and to investigate the diagnostic value of biomarkers for pediatric AKI.Methods From June 2016 to March 2017,a total of 60 patients who were hospitalized in the department of pediatric in our hospital and the second xiangya hospital of central south university were selected as research objects.They were assigned to AKI group（30 cases） and non-AKI group（30 cases） according to the definition by the AKIN criteria.Also 24 healthy children of the same age were recruited as the control group.The clinical characteristics and influencing factors of AKI children were analyzed,and the biomarkers of different groups of children were observed and the diagnostic value of different biomarkers for AKI was compared.Results The common causes of AKI were sepsis,drug intoxication,severe allergic purpura and snakebite.Height and weight had a higher correlation with AKI（P〈0.05）.At 2 hours after hospitalization,except SCr,the levels of urine KIM-1,NGAL,L-FABP,serum Cys C,and serum NGAL were significantly higher in AKI group than those in non-AKI group,and the differences were statistically significant（P〈0.01）.At 48 hours after hospitalization,the levels of SCr were significantly higher in AKI group than those in non-AKI group,and the differences were statistically significant（P〈0.01）.Although the levels of other biomarkers in AKI group declined,they were still significantly higher than those in non-AKI group,and the differences were statistically significant（P〈0.01）.At 2 hours after hospitalization,the value for the AUC was determined for urine KIM-1,NGAL,L-FABP,serum Cys C,NGAL and SCr was0.912,0.922,0.909,0.906,0.943 and 0.533 respectively.At 48 hours after hospitalization,the value for the AUC was determined for urine KIM-1,NGAL,L-FABP,serum Cys C,NGAL and SCr was 0.887,0.904,0.858,0.818,0.889 and 0.942 respectively.Conclusions AKI is associated with the disease severity.Height and weight may be the influence factors of pediatric AKI in renal pathologic conditions.The serum level of NGAL may have good reference value for early clinical diagnosis of AKI,SCr is still an important predictor of AKI.