ALR、β2-MG联合Scr对重症急性胰腺炎合并急性肾损伤的早期预测价值

The value of ALR and β2-MG combined with Scr in early prediction of severe acute pancreatitis and acute kidney injury

目的:探究肝再生增强因子(ALR)、血清β2微球蛋白(β2-MG)联合血肌酐(Scr)对重症急性胰腺炎(SAP)合并急性肾损伤(AKI)的早期预测价值。方法:采用前瞻性研究方法,选取2016年1月至2018年1月河北省廊坊市人民医院ICU收治的SAP患者82例,监测患者入院0 h、6 h、12 h、24 h、48 h、72 h血ALR、尿β2-MG和Scr水平,并根据其是否并发AKI,分为AKI组和非AKI组,运用受试者工作特征(ROC)曲线,分析不同时段血ALR、尿β2-MG和Scr预测SAP合并AKI的价值。结果:SAP合并AKI患者31例(37.80%,AKI组),SAP非AKI患者51例(62.20%,非AKI组)。AKI组入院6 h血ALR明显升高,入院12 h达到峰值,入院6 h、12 h、24 h、48 h、72 h,AKI组血ALR和尿β2-MG水平高于非AKI组(P<0.05);入院6 h、12 h、24 h、48 h、72 h,AKI组Scr水平高于非AKI组(P<0.05)。入院12 h血ALR水平预测AKI的灵敏度为0.876,特异度为0.884,ROC曲线下面积(AUC)为0.892;入院24 h尿β2-MG灵敏度为0.868,特异度为0.874,AUC为0.883;入院72 h Scr水平灵敏度为0.865,特异度为0.884,AUC为0.861;入院12 h血ALR、24 h尿β2-MG和72 h Scr构建联合联合预测模型,灵敏度为0.916,特异度为0.934,AUC为0.965,高于单项预测指标。结论:ALR、β2-MG联合Scr对SAP合并AKI早期预测价值较高,可用于临床早期诊断。

Objective: To explore the early prediction value of augmenter of liver regeneration(ALR),β2-microglobulin(β2-MG) combined with serum creatinine(Scr) for severe acute pancreastitis(SAP) combined with acute kidney injury(AKI). Methods: A prospective study was performed on 82 ICU severe SAP patients from January 2016 to January 2018.Serum ALR,urine β2-MG and Scr levels at 0 h,6 h,12 h,24 h,48 h,and 72 h after admission were monitored.The value of serum ALR,urine β2-MG and Scr in predicting SAP combined with AKI in different time points was analyzed by ROC curve. Results: A total of 31 SAP combined with AKI patients(37.80%,AKI group) and 51 SAP without AKI patients(62.20%,non-AKI group) were identified.The serum ALR in AKI group was significantly increased at 6 h post-admission,and reached its peak at 12 h.Serum ALR and urine β2-MG levels at 6 h,12 h,24 h,48 h and 72 h in AKI group were higher than those in the non-AKI group.The Scr level at 12 h,24 h,48 h and 72 h in AKI group was higher than that in non-AKI group( P <0.05).The sensitivity of ALR for predicting AKI at 12 h post-admission was 0.876,specificity was 0.884,and the area under the ROC curve(AUC) was 0.892.The sensitivity of β2-MG at 24 h post-admission was 0.868,specificity was 0.874,and AUC was 0.883.The sensitivity of Scr at 72 h was 0.865,specificity was 0.884,and AUC was 0.861.The sensitivity of ALR at 12 h,β2-MG at 24 h combined with Scr at 72 h was 0.916,specificity was 0.934,and AUC was 0.965,which was higher than that of ALR,β2-MG or Scr only( P <0.05). Conclusion: Serum ALR,urine β2-MG combined with Scr was valuable for the prediction of SAP combined with AKI,and the combination could be used for early diagnosis in clinic.