肾脏相关生物标志物在脓毒症急性肾损伤早期评价中的临床意义

Clinical significance of renal biomarkers for early evaluation of acute kidney injury in sepsis

目的探讨肾脏相关生物标志在脓毒症患者急性肾损伤(AKI)早期评价中的临床意义。方法选择2018年7至12月南通大学附属医院收治的60例脓毒症患者,其中29例患者并发AKI(AKI组),31例患者未并发AKI组(非AKI组)。收集并比较2组患者尿量、血肌酐、血尿素氮、血β2微球蛋白、血中性粒细胞明胶酶相关载脂蛋白(NGAL)、血清胱抑素C、降钙素原(PCT)、氨基末端脑钠肽前体(NT-proBNP)及尿蛋白水平。采用单因素及多因素Logistic回归分析筛选脓毒症患者发生AKI的危险因素。绘制各项生物标志物预测脓毒症患者发生AKI的受试者工作特征(ROC)曲线。结果AKI组患者尿量、血肌酐、血尿素氮、血β2微球蛋白、血NGAL、血清胱抑素C、PCT、NT-proBNP、尿蛋白水平均高于非AKI组患者,且差异均有统计学意义(t=1.754,P=0.021;t=-3.851,P<0.001;t=-4.972,P<0.001;t=-7.645,P<0.001;t=-3.451,P=0.001;t=-4.880,P<0.001;t=-3.231,P=0.002;t=-3.636,P=0.001;u=-2.775,P=0.006)。多因素Logistic回归分析结果显示,血NGAL、血清胱抑素C、NT-proBNP水平是脓毒症患者发生AKI的多因素危险因素(P=0.015、0.002、0.023)。ROC曲线显示,血NGAL、血清胱抑素C、NT-proBNP水平预测脓毒症患者发生AKI的曲线下面积分别为0.840、0.894、0.743,预测脓毒症患者发生AKI较为敏感。结论血NGAL、血清胱抑素C、NT-proBNP是预测脓毒症患者发生AKI较为敏感的指标。

Objective To evaluate the clinical significance of renal biomarkers for early evaluation of acute kidney injury(AKI)in sepsis.Methods This is a prospective case-control study of 60 patients with sepsis admitted to Affiliated Hospital of Nantong University.According to the diagnostic criteria of the Kidney Disease:Improving Global Outcomes(KDIGO),the patients were divided into either an AKI group or a non-AKI group.Urine volume,serum creatinine(SCr),blood urea nitrogen(BUN),bloodβ2 microglobulin,blood neutrophil gelatinase-associated lipocalin(NGAL),serum cystatin C,procalcitonin(PCT),amino terminal brain natriuretic peptide precursor(NT-proBNP),and urine protein were analyzed and compared between the two groups.The statistically significant factors in univariate analysis were further analyzed by multivariate logistic regression analysis.The accuracy of different indicators in predicting concurrent AKI in patients with sepsis was also evaluated.Results Urine volume,SCr,BUN,bloodβ2 microglobulin,blood NGAL,serum cystatin C,PCT,NT-proBNP and urine protein in the AKI group were significantly higher than those in the non-AKI group(t=1.754,P=0.021;t=-3.851,P<0.001;t=-4.972,P<0.001;t=-7.645,P<0.001;t=-3.451,P=0.001;t=-4.880,P<0.001;t=-3.231,P=0.002;t=-3.636,P=0.001;u=-2.775,P=0.006).Multivariate logistic regression analysis demonstrated that blood NGAL,serum cystatin C,and NT-proBNP were independent risk factors for AKI(P=0.015,0.002,0.023).The areas under the ROC curves of blood NGAL,serum cystatin C,and NT-proBNP were 0.840,0.894,and 0.743,respectively.Conclusion Blood NGAL,serum cystatin C,and NT-proBNP are sensitive indicators for predicting AKI in patients with sepsis.