血液生物标志物对预测ICU患者急性肾损伤及判断预后的价值分析

Analysis on the value of blood biomarkers in predicting acute renal injury in ICU patients and determination of prognosis

目的探讨血液生物标志物对急性肾损伤(AKI)的预测及判断预后临床价值。方法连续选择2012年10月~2014年11月在浙江省人民医院重症医学科(ICU)住院220例患者为研究对象。所有研究对象均于入住ICU后24 h内留取血液标本检测中性粒细胞明胶酶相关载脂蛋白(NGAL)及肾损伤分子-1(KIM-1)水平,并记录患者的一般临床资料及28 d生存率等。结果共纳入218例患者,其中152例(69.7%)最终发生AKI,发生AKI患者NGAL水平为(234.1±32.5)ng/m L,未发生AKI患者为(63.2±12.4)ng/m L,差异具有统计学意义(P<0.05)。AKI患者KIM-1为(5.26±1.20)ng/m L,未发生AKI患者为(1.47±0.53)ng/m L,差异具有统计学意义(P<0.05)。NGAL预测AKI敏感性及特异性分别为81.6%和81.8%,预测CRRT时机敏感性及特异性为74.4%和66.7%。KIM-1预测AKI敏感性及特异性分别为75.7%和75.8%,预测CRRT时机敏感性及特异性分别为76.7%和75.0%,预测死亡率敏感性及特异性分别为70.1%和68.5%。结论对ICU患者检测血液中的NGAL及KIM-1水平对于早期发现AKI、预测CRRT使用时机及评估患者预后具有极高的临床价值。

Objective To investigate the clinical value of blood biomarkers in the prediction of acute kidney injury（A- KI） and evaluation of prognosis. Methods A total of 220 hospitalized patients who were admitted to the intensive care unit （ICU） of Zhejiang People＇s Hospital from October 2012 to November 2014 were selected as the study subjects. All study subjects were enrolled in the ICU within 24 hours after blood samples were collected to detect neutrophil gelati- nase-assoeiated apolipoprotein （NGAL） and renal injury molecule-1 （KIM-1） levels, and the general clinical data and 28-day survival rate were recorded. Results A total of 218 patients were included. Of these, 152 cases （69.7%） were eventually developed into AKI. The level of NGAL in patients with AKI was（234.1±32.5） ng/mL, and the level was （63.2±12.4） ng/mL in the patients without AKI. The difference was statistically significant（P〈0.05）. KIM-1 in patients with AKI was（5.26±1.20） ng/mL, and KIM-1 in the patients without AKI was（1.47±0.53） ng/mL. The difference was sta tistically significant（P〈0.05）. The sensitivity and specificity of NGAL in predicting AKI were 81.6% and 81.8%, respec- tively. The sensitivity and specificity in predicting CRRT timing were 74.4% and 66.7% respectively. The sensitivity and specificity of KIM-1 in predicting AKI were 75.7% and 75.8% respectively. The sensitivity and specificity in pre- dicting CRRT timing were 76.7% and 75.0% respectively. The sensitivity and specificity in predicting mortality were 70.1% and 68.5% respectively. Conclusion The detection of NGAL and KIM-1 levels in blood of ICU patients is of great clinical value for early detection of AKI, prediction of application timing of CRRT and evaluation of prognosis of patients.