胶质纤维酸性蛋白对HIE患儿早期肾功能损伤的评价分析

Evaluation and Analysis of Glial Fibrillary Acidic Protein on Early Renal Damage in Children with HIE

目的:探究胶质纤维酸性蛋白(glial fibrillary acidic protein,GFAP)对缺氧缺血性脑病(hypoxic ischemic encephalopathy,HIE)患儿早期肾功能损伤的评估价值。方法:选择2019年1-12月于本院接受治疗的80例HIE合并早期肾损伤患儿为A组,80例HIE患儿为B组,选择同期来院接受体格检查的50例健康儿童为C组。比较三组的GFAP、尿素氮(BUN)、血清肌酐(Scr)水平。将A组患儿按照肾功能损伤严重程度为轻度(23例)、中度(30例)和重度(27例),比较不同肾功能损伤程度患儿GFAP、BUN、Scr水平,绘制受试者工作曲线(ROC曲线),计算GFAP、BUN和Scr的ROC曲线下面积(AUC)及上述指标诊断HIE患儿早期肾功能损伤的灵敏度、特异度、阳性预测值、阴性预测值。结果:A组的GFAP、BUN、Scr水平均明显高于B、C组,差异均有统计学意义(P<0.05);B组和C组的GFAP、BUN、Scr水平比较,差异均无统计学意义(P>0.05)。A组不同肾功能损伤程度患儿GFAP水平比较,差异有统计学意义(P<0.05)。A组重度肾功能损伤患儿GFAP水平明显高于轻度肾功能损伤患儿,差异均有统计学意义(P<0.05)。ROC曲线显示GFAP、BUN、Scr对HIE早期肾功能损伤的AUC分别为0.979 3、0.966 0、0.853 3,最佳阈值分别为128.70 ng/L、3.65 mmol/L、69.50 μmol/L。GFAP诊断HIE患儿早期肾功能损伤的灵敏度和阴性预测值优于BUN和Scr指标。结论:GFAP可以作为HIE患儿早期肾功能损伤的内源标志物之一,其水平会随着患儿肾功能损伤严重程度而变化,值得将其进行临床推广应用。

Objective:To investigate the value of glial fibrillary acidic protein (GFAP) in assessing early renal function impairment in children with hypoxic ischemic encephalopathy (HIE).Method:A total of 80 children with HIE combined with early renal injury who received treatment in our hospital from January to December 2019 were selected as group A,80 children with HIE as group B,and 50 healthy children who came to our hospital for physical examination during the same period were selected as group C.GFAP,BUN and serum creatinine (Scr) levels were compared in three groups.Children in group A were divided into mild (23 cases),moderate (30 cases) and severe (27 cases) according to the severity of renal function injury.The levels of GFAP,BUN and Scr in children with different renal function injury were compared.The receiver operating curve (ROC) was drawn,and the area under ROC curve (AUC) of GFAP,BUN and Scr was calculated.The sensitivity,specificity,positive predictive value and negative predictive value of the above indicators in the diagnosis of early renal injury in HIE children were calculated.Result:The levels of GFAP,BUN and Scr in group A were significantly higher than those in group B and C,the differences were statistically significant (P<0.05).Comparison of GFAP,BUN,Scr levels between group B and group C,there were no statistically significant differences (P>0.05).Comparison of GFAP levels in children with different renal function injury degree in group A,the difference was statistically significant (P<0.05).In group A,the level of GFAP in children with severe renal function impairment was significantly higher than that in children with mild renal function impairment,the differences were statistically significant (P<0.05).ROC curve showed that the AUC of GFAP,BUN and Scr on HIE early renal function injury were 0.979 3,0.966 0 and 0.853 3,respectively,and the optimal thresholds were 128.70 ng/L,3.65 mmol/L and 69.50 μmol/L,respectively.The sensitivity and negative predictive value of GFAP in the diagnosis of early renal function injury in HIE children were better than BUN and Scr indexes.Conclusion:GFAP can be used as one of the endogenous markers of early renal function injury in children with HIE,and its level will change with the severity of renal function injury in children,which is worthy of its clinical promotion and application.