sNGAL、uNGAL及uKIM-1水平在重症监护病房急性肾损伤中的应用价值

The Application Value of sNGAL,uNGAL and uKIM-1 Levels in Acute Kidney Injury in Intensive Care Unit

目的探究血清中性粒细胞胶原酶相关脂质运载蛋白(sNGAL)、尿NGAL(uNGAL)、尿肾损伤因子(uKIM-1)等指标在重症监护病房急性肾损伤(AKI)中的应用价值。方法选择2016年1月至2019年1月我院重症监护病房收治患者作为研究对象,收集患者临床资料、入院时急性及慢性健康评分(APACHEII)、序贯器官衰竭估计评分(SOFA),进行AKI分级并测定sNGAL、uNGAL及uKIM-1等指标水平。结果共纳入105例ICU患者,42例患者被诊断为AKI,其中AKIN I期15例,AKIN II期16例,AKIN III期11例;AKI组患者APACHEII、SOFA评分显著高于非AKI组(P<0.05),血肌酐显著高于非AKI组,24 h尿量显著低于非AKI组(P<0.05);与非AKI组比较,AKI组患者sNAGL、uNAGL及uKIM-1水平升高(P<0.05),随着AKI分级升高,各指标水平升高幅度增加(P<0.05);sNAGL、uNAGL及uKIM-1诊断AKI患者曲线下面积分别为0.813、0.845、0.823,诊断截点值分别为172.5μg/L、192.0μg/L及2.06 ng/L。结论急性肾损伤患者可伴有sNAGL、uNAGL及uKIM-1等指标水平的升高,且升高幅度与肾损伤严重程度相关,可用于早期诊断急性肾损伤。

Objective To investigate the application value of indicators such as serum neutrophil gelatinase-associated lipocalin(sNGAL),urinary NGAL(uNGAL)and urinary kidney injury molecule(uKIM-1)in acute kidney injury(AKI)in intensive care unit(ICU).Methods Patients admitted to ICU of the hospital between January,2016 and January,2019 were selected as the study subjects.Clinical data,acute physiological and chronic health evaluation(APACHE II)scores and sequential organ failure assessment(SOFA)scores at admission were collected.AKI was graded and the levels of indicators such as sNGAL,uNGAL and uKIM-1 were measured.Results A total of 105 patients were admitted to ICU.Among them,42 patients were diagnosed with AKI,including 15 cases at stage I,16 cases at stage II and at stage III.The APACHEII and SOFA scores of the AKI group were significantly higher than those of the non-AKI group(P<0.05).Also,for the AKI group,serum creatinine was significantly higher than the non-AKI group while 24h urine volume was significantly smaller than the non-AKI group(P<0.05).The levels of sNAGL,uNAGL and uKIM-1 were all higher in the AKI group than in the non-AKI group(P<0.05).With the increase of the grade of AKI,the increase of each index level increased(P<0.05).The areas under the curves of sNAGL,uNAGL and uKIM-1 for diagnosis of AKI were 0.813,0.845 and 0.823,respectively,and the diagnostic cutoff values were 172.5μg/L,192.0μg/L and 2.06 ng/L,respectively.Conclusion Patients with AKI have elevated levels of sNAGL,uNAGL and uKIM-1,and the increase is related to the severity of kidney injury.These markers can be used for the early diagnosis of AKI.