重症医疗单元中急性肾损伤患者新生预后预测因子的研究进展

Reserch progress on novel prognostic predictors of acute renal injure in intensive care unit

尽管目前为止的研究已经对急性肾损伤(acute kidney injure,AKI)的发病机制及治疗策略有了一定的探索,但AKI的死亡率仍居高不下,仍然是重症医疗单元中重要的死亡因素之一。早期甄别AKI患者,有助于展开更积极的治疗,改善患者的预后。血清肌酐水平作为诊断肾脏损伤的金标准,在早期AKI的诊断中敏感性和特异性都不能满足目前临床工作的需要。因此,在过去的几十年中,科研工作者们致力于发现和验证新的AKI标志物,包括中性粒细胞明胶酶相关脂质运载蛋白、白细胞介素-18、肾脏损伤分子-1、半胱氨酸蛋白酶抑制物C等,研究表明这些生物标志物可能是AKI发展和预后的可靠预测因子,对AKI的早期诊断和临床监测也具有重要的意义。该文将针对近年来这些新生AKI预后预测因子的主要研究及成果进行综述总结,评价其在早期诊断和临床预后预测中的作用和局限性,以期对临床及进一步的科研工作有所帮助。

Although the recent studies have concerned the pathogenesis and therapeutic strategies of acute kidney injury（AKI）, the mortality of AKI is still terribly high, and it is still one of the most important death factors in the intensive care unit. There is no doubt that early verdict of AKI, is good for a more aggressive treatment and can promise an improved prognosis for AKI patients. Serum creatinine level, serving as the gold standard for diagnosis of kidney injury, cannot meet current clinical work in its sensitivity and specificity of diagnosis of early AKI. Over the past decades,researchers worked to find and verify novel AKI biomarkers, including neutrophil gelatinase associated lipocalin,interleukin-18, kidney injury molecule-1 and cystatin-C, which were proved to be the potential reliable predictor of AKI development and prognosis, and were of great importance to the early diagnosis and clinical monitoring of AKI. This paper reviews the main studies on these novel prognostic predictors of AKI over the decades and evaluates their roles and limitations in early diagnosis and clinical prognosis prediction.