CysC、uNGAL、uMA/Cr对脓毒症早期急性肾损伤的诊断价值

Diagnostic value of CysC,uNGAL and uMA/Cr for early acute kidney injury due to sepsis

目的分析胱抑素C(CysC)、尿中性粒细胞明胶酶相关脂质运载蛋白(uNGAL)、尿微量白蛋白肌酐比值(uMA/Cr)对脓毒症早期急性肾损伤(SAKI)的诊断价值。方法选取2016年5月至2018年1月收治的脓毒症患者120例,其中54例出现SAKI者纳入SAKI组,66例未出现SAKI者纳入单纯脓毒症组,另选择同期健康志愿者30例为对照组,比较3组临床资料及入院时(脓毒症患者另监测入ICU 3 d、7 d时)CysC、uNGAL、uMA、Scr水平、uMA/Cr比值,分析各指标相关性及对SAKI的早期预警价值。结果与对照组比较,SAKI组、单纯脓毒症组入院时乳酸、降钙素原、CysC、uNGAL、uMA、Scr、uMA/Cr比值较高(P<0.05),SAKI组入院时乳酸、降钙素原、CysC、uNGAL、uMA、uMA/Cr比值、住院时间、28 d死亡率高于单纯脓毒症组(P<0.05);SAKI组、单纯脓毒症组入ICU 7 d CysC、uNGAL、uMA、Scr、uMA/Cr比值较入ICU 3 d下降(P<0.05),且SAKI组入ICU 3 d、7 d CysC、uNGAL、uMA、uMA/Cr比值高于单纯脓毒症组(P<0.01);相关性分析发现,SAKI患者入院时CysC、uNGAL、uMA/Cr比值与住院时间、28 d死亡率呈正相关(P<0.05)。ROC曲线分析显示,入院时CysC、uNGAL、uMA/Cr比值对早期SAKI有较高预警价值,其AUC分别为0.715、0.778、0.726。结论CysC、uNGAL、uMA/Cr对早期SAKI有较高诊断价值,尤其是uNGAL预警价值最高,应加以监测。

Objective To investigate the diagnostic value of cystatin C(CysC),urinary neutrophil gelatinase-associated lipocalin(uNGAL)and the ratio of urinary microalbumin to creatinine(uMA/Cr)for early acute kidney injury due to sepsis(SAKI).Methods A total of 120 patients with sepsis who were treated in our hospital from May 2016 to January 2018 were enrolled in the study.The 54 patients with SAKI were enrolled as SAKI group,and the other 66 patients without SAKI were enrolled as simple sepsis group,at the same time,the 30 healthy volunteers were enrolled as control group.The clinical data,the levels of CysC,uNGAL,uMA,Scr and the ratio of uMA to Cr at admission were observed and comapred among the three groups.Moreover the correlation of these indexes and early warning value for SAKI were analyzed.Results As compared with those in control group,the levels of lactic acid,procalcitonin,CysC,uNGAL,uMA,Scr,the ratio of uMA to Cr in SAKI group and simple sepsis group were significantly increased(P<0.05).The levels of lactic acid,procalcitonin,CysC,uNGAL,uMA,the ratio of uMA to Cr at admission,and hospitalization time,28d mortality in SAKI group were significantly higher than those in simple sepsis group(P<0.05).The levels of CysC,uNGAL,uMA,Scr,the ratios of uMA to Cr in SAKI group and simple sepsis group at 7 days after entering ICU were significantly decreased,as compared with those at 3 days after entering ICU(P<0.05),moreover,the levels of CysC,uNGAL,uMA,the ratio of uMA to Cr in SAKI group at 3 days and 7 days after entering ICU were significantly higher than those in simple sepsis group(P<0.01).Correlation analysis showed that the levels of CysC,uNGAL,the ratio of uMA to Cr at admission in SAKI group were positively correlated with hospitalization time and 28-day mortality(P<0.05).The ROC curve analysis showed that CysC,uNGAL and the ratio of uMA to Cr at admission had higher early warning value for SAKI,and the AUC was 0.715,0.778,0.726,respectively.Conclusion The CysC,uNGAL and uMA/Cr have higher diagnostic value for early SAKI,especially uNGAL has the highest warning value,which should be monitored.