尿液uNGAL、sCys-C和IL-18联合检测在评价脓毒症急性肾损伤治疗效果中的应用价值

The Value of Combined Detection of Urine uNGAL,sCys-C and IL-18 in Evaluating the Therapeutic Effect of Acute Kidney Injury in Sepsis

目的探讨尿液中性粒细胞胶原酶相关脂质运载蛋白(urinary neutrophil gelatinase associated lipocalin,uNGAL)、半胱氨酸蛋白酶抑制剂C(sCys-C)、及尿白介素18(IL-18)联合检测在评价脓毒症并发急性肾损伤治疗效果中的临床价值。方法收集本院2016年1月至2018年1月收治的脓毒症并发急性肾损伤患者100例,随机分为对照组(n=50,常规治疗)和观察组(n=50,CRRT标准治疗),检测患者入院后0、12、24、48h时尿液uNGAL、sCys-C和IL-18水平,观察记录两组患者急性生理学及慢性健康评分(APACHEⅡ)及病死率。结果不同时间点,观察组和对照组根据不同的临床分期RISK(Ⅰ期)、INJURY(Ⅱ期)、FAILURE(Ⅲ期)比较可得,患者12、24、48 h内uNGAL、sCys-C和IL-18水平显著低于Oh(P <0.05)。相同时间点,与对照组比较,观察组患者12、24、48 h内uNGAL、sCys-C和IL-18水平显著降低(P <0.05)。通过直线相关分析结果发现,脓毒症并发急性肾损伤尿液uNGAL、sCys-C和IL-18水平与疾病严重程度存在显著的正相关关系,Person相关系数为正值,P<0.05。3项生物学标志物单独及联合检测ROC曲线下面积由大到小依次为:联合检测、uNGAL、sCys-C和IL-18。并联试验灵敏度为92.0%,串联试验特异性(采用)为95.0%,显著高于各单项生物学标志物检测(P <0.05)。结论 CRRT标准化治疗能够显著降低脓毒症并发急性肾损伤患者尿液中uNGAL、sCys-C和IL-18水平;尿液uNGAL、sCys-C和IL-18联合检测可作为评价脓毒症并发急性肾损伤的重要生物学指标。

Objective To investigate the therapeutic values of the combined detection of urinary neutrophil gelatinase associated lipocalin(uNGAL),cysteine protease inhibitor C(sCys-C),and urinary interleukin 18(IL-18)for sepsis complicated with acute kidney injury.Methods 100 patients with sepsis complicated with acute kidney injury admitted from January,2016 to January,2018 were randomly divided into the control group(n=50,routine treatment)and the observation group(n=50,CRRT standard Treatment).The expressions of urine uNGAL,sCys-C and IL-18 were measured at 0,12,24,48 h after the admission.The acute physiology and chronic health score(APACHE II)and mortality were also recorded.Results At different time points,the observation group and the control group were diagnosed according to different clinical stages of RISK(stage I),INJURY(stage II),and FAILURE(stage III).The patients had uNGAL and sCys-C within 12,24,and 48 hours.And IL-18 was significantly lower than 0h(P<0.05).At the same time point,compared with the control group,the levels of uNGAL,sCys-C and IL-18 were significantly lower in the observation group(P<0.05).The results of linear correlation analysis showed that there was a significant positive correlation between the levels of uNGAL,sCys-C and IL-18 with sepsis complicated with acute kidney injury,and the correlation coefficient of Pearson was positive,P<0.05.The area under the ROC curve for the each biomarker alone and the combination were ranked as following:joint detection,uNGAL,sCys-C and IL-18.The parallel test sensitivity was 92.00%,and the tandem test specificity(used)was 95.00%,which were significantly greater than the individual biomarker tests(P<0.05).Conclusion CRRT standardized treatment can significantly reduce the levels of uNGAL,sCys-C and IL-18 in urine of patients with sepsis complicated with acute kidney injury;combined detection of urine uNGAL,sCys-C and IL-18 can be used to evaluate sepsis and serves as an important biological indicator of acute kidney injury.