尿肾损伤分子-1对单侧梗阻性肾病肾功能早期评估的价值

Application value of urine kidney injury molecule-1 in early evaluating the renal function for unilateral obstruction renal disease

目的 探讨尿肾损伤分子-1（KIM-1）水平对单侧梗阻性肾病肾功能早期评估的价值.方法 选取单侧梗阻性肾病患者78例,以99Tcm-二乙烯三胺五乙酸（DTPA）肾动态显像测定肾小球滤过率（GFR）,根据GFR将患者分为四组：肾功能正常组[GFR〉40ml/（min·1.73m2）,A组]25例,肾功能轻度损伤组[20ml/（min·1.73m2）〈GFR≤40ml/（min·1.73m2）,B组]22例,肾功能中度损伤组[10ml/（min·1.73m2）〈GFR≤20ml/（min·1.73m2）,C组]16例,肾功能重度损伤组[GFR≤10ml/（min·1.73m2）,D组]15例.另外选取25例健康体检者作为对照组（E组）.各组检测尿KIM-1,并抽血检测血清肌酐和血尿素氮.对KIM-1、血清肌酐、血尿素氮与患肾GFR进行相关性分析.结果 A组、B组、C组、D组尿KIM-1明显高于E组[（49.70±9.23）、（57.84±10.06）、（67.71±7.36）和（65.84±22.48）ng/L比（39.17±3.28）ng/L],A组和B组明显高于C组和D组,A组明显高于B组,差异有统计学意义（P〈0.05）;C组与D组比较差异无统计学意义（P〉0.05）.五组间血清肌酐和血尿素氮比较差异无统计学意义（P〉0.05）.尿KIM-1与患肾GFR呈负相关（r=-0.441,P〈0.01）,血清肌酐和血尿素氮与患肾GFR无相关性（r=-0.115和0.019,P〉0.05）.受试者工作特征（ROC）曲线分析结果显示,尿KIM-1在患肾损伤诊断时曲线下面积（AUC）明显大于血清肌酐和血尿素氮（0.804比0.441和0.567）;敏感度和特异度分别为82.6%和66.7%、56.5%和53.3%、66.9%和66.7%.结论 尿KIM-1在单侧梗阻性肾病不同程度肾损伤时的表达水平不同,敏感度明显高于传统肾功能评估指标血清肌酐和血尿素氮,提示了尿KIM-1作为早期判断肾功能损伤生物标志物的潜在临床应用价值.

Objective To study the early renal function assessment value of urine kidney injury molecule-1（KIM-1）level in patients with unilateral obstruction renal diseases.Methods Seventy-eight patients with unilateral obstruction renal diseases were selected,and the glomerular filtration rate（GFR） was detected by 99Tcm-diethylene triaminepentaacetic acid （DTPA） renal dynamic imaging method. The patients were divided into 4 groups according to the GFR： normal renal function group with GFR〉40 ml/（min·1.73 m2）25 cases（A group）,low-injury renal function group with 20 ml/（min·1.73 m2）〈GFR≤40 ml/（min·1.73 m2） 22 cases （B group）, mid-injury renal function group with 10 ml/（min·1.73 m2） 〈GFR ≤ 20 ml/（min·1.73 m2） 16 cases （C group）, serious-injury renal function group with GFR ≤ 10 ml/（min·1.73 m2） 15 cases （D group）. Twenty-five healthy people were selected as control group （E group）. The urine KIM-1 and serum creatinine and blood urea nitrogen levels were detected. The correlation among urine KIM-1, serum creatinine and blood urea nitrogen was analyzed. Results The urine KIM-1 in A group, B group, C group and D group was significantly higher than that in E group：（49.70 ± 9.23）,（57.84 ± 10.06）,（67.71 ± 7.36）and（65.84 ± 22.48）ng/L vs.（39.17 ± 3.28）ng/L,in A group and B group was significantly higher than that in C group and D group,in A group was significantly higher than that in B group, and there were statistical differences （P〈0.05）. There was no statistical difference in urine KIM-1 between C group and D group（P〉0.05）.There was no statistical difference in serum creatinine and blood urea nitrogen among 5 groups （P〉0.05）. The KIM-1 was negatively correlated with GFR（r=-0.441,P〈0.01）,and the serum creatinine and blood urea nitrogen were not correlated with GFR （r = -0.115 and 0.019, P〉0.05）. The receiver operating characteristic curve analysis result showed that the area under curve of urine KIM-1 in the diagnosis of kidney injury was significantly higher than that in serum creatinine and blood urea nitrogen（0.804 vs.0.441 and 0.567）;the sensitivity and specificity were 82.6% and 66.7%,56.5% and 53.3%,66.9% and 66.7%.Conclusions The expression level of urine KIM-1 of unilateral obstructive nephropathy with different degree of kidney injury is a higher sensitivity marker compared with serum creatinine and blood urea nitrogen, which is helpful for diagnosing kidney injury early in clinic.