血清胱抑素C联合视黄醇结合蛋白检测在新生儿败血症继发肾损伤中的预测价值

Predictive value of serum cystatin C combined with retinol-binding protein detection in neonates with kidney injury secondary to sepsis

目的探讨血清胱抑素C(CysC)及视黄醇结合蛋白(RBP)联合检测对新生儿败血症继发急性肾损伤(AKI)的预测价值。方法分析82例败血症足月新生儿的临床资料,根据是否继发AKI分为AKI组(34例)和非AKI组(48例),并随机选取同期50例因母亲孕期异常入院但无器质性疾病的足月新生儿为对照组。评估3组血清CysC及RBP水平差异,并采用受试者工作特征(ROC)曲线下面积(AUC)分析CysC和RBP联合检测对诊断新生儿败血症继发AKI的价值。结果AKI组血清CysC及RBP水平高于非AKI组及对照组,差异有统计学意义(P<0.05);非AKI组血清CysC及RBP水平与对照组比较,差异无统计学意义(P>0.05)。AKI 2期和3期患儿血清CysC及RBP水平高于1期患儿,合并症组高于无合并症组,预后不良组明显高于预后良好组,差异有统计学意义(P<0.05)。血清CysC及RBP单独诊断新生儿败血症后继发AKI的敏感度分别为82.4%、73.5%,特异度分别为70.8%、79.2%。2种指标联合检测的敏感度和特异度分别为88.2%、70.7%。结论新生儿败血症继发AKI时,血清CysC及RBP水平会升高,这两项指标在预测新生儿败血症继发AKI中具有较高的可靠性,联合检测两种标志物有助于提高对AKI的预测能力。

Objective To investigate the predictive value of serum cystatin C(CysC)combined with retinol-binding protein(RBP)in neonates with acute kidney injury(AKI)secondary to sepsis.Methods The clinical data of 82 full-term neonates with sepsis was analyzed.They were divided into AKI group(34 cases)and non-AKI group(48 cases)according to occurrence of secondary AKI.Another 50 full-term newborns without organic diseases admitted to our department due to abnormal pregnancy were randomly selected as control group.The differences of serum CysC and RBP levels among the three groups were evaluated,and the area under the curve(AUC)of Receiver operator characteristic(ROC)curve was used to analyze the value of CysC and RBP in the diagnosis of AKI secondary to neonatal sepsis.Results The levels of serum CysC and RBP in the AKI group were significantly higher than those in the non-AKI group and control group(P<0.05),and there were no significant differences in above indicators between non-AKI group and control group(P>0.05).The levels of serum CysC and RBP in patients in AKI stage 2 and 3 were significantly higher than those in AKI stage 1,and the above indicators in the complication group and poor-prognosis group were significantly higher than the non-complication group and good-prognosis group(P<0.05).The sensitivities of serum CysC or RBP alone in the diagnosis of AKI secondary to neonatal sepsis were 82.4%and 73.5%respectively,and the specificities were 70.8%and 79.2%respectively.The sensitivity and specificity of combined indicators were 88.2%and 70.7%respectively.Conclusion The levels of serum CysC and RBP will significantly increase in neonates with renal injury secondary to sepsis.The two indicators have high reliability in predicting AKI secondary to neonatal sepsis,and the combination of the two markers can help to improve the prediction ability of AKI.