尿肾损伤标志物预测重度窒息新生儿急性肾损伤的临床研究

The predictive value of NGAL and KIM-1 for acute kidney injury in neonates with severe asphyxia

目的探讨尿肾损伤标志物中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipoprotein,NGAL)和肾损伤分子1(kidney injury molecule-1,KIM-1)对新生儿重度窒息后急性肾损伤(acute kidney injury,AKI)的早期预测价值。方法选择2019年1月至2020年6月生后6 h内入住上海市儿童医院新生儿科的重度窒息新生儿进行前瞻性研究。观察患儿入院当时、生后24 h、48 h和1周尿肾损伤标志物NGAL和KIM-1水平的动态变化,并依据是否发生AKI分为AKI组和非AKI组。应用受试者工作特征曲线评价患儿不同时间NGAL和KIM-1预测AKI的敏感度和特异度。结果共纳入重度窒息新生儿51例,其中AKI组9例,非AKI组42例,AKI发生率17.6%。AKI组和非AKI组入院时尿NGAL水平分别为(115.6±75.5)ng/ml和(49.8±29.0)ng/ml,生后24 h分别为(90.7±35.6)ng/ml和(55.6±30.7)ng/ml,差异均有统计学意义(P<0.05);生后48 h和生后1周差异无统计学意义(P>0.05)。AKI组和非AKI组生后24 h尿KIM-1水平分别为(808.3±555.3)pg/ml和(318.4±234.0)pg/ml,差异有统计学意义(P<0.05);入院时、生后48 h和生后1周差异无统计学意义(P>0.05)。重度窒息新生儿入院时、生后24 h、生后48 h和生后1周尿NGAL预测AKI的受试者工作特征曲线下面积分别为0.804(95%CI 0.573~1.000)、0.792(95%CI 0.580~1.000)、0.732(95%CI 0.517~0.947)和0.551(95%CI 0.371~0.730),尿KIM-1预测AKI的受试者工作特征曲线下面积分别为0.860(95%CI 0.676~1.000)、0.824(95%CI 0.655~0.993)、0.768(95%CI 0.622~0.914)和0.622(95%CI 0.392~0.852)。结论重度窒息新生儿入院时、生后24 h和生后48 h尿肾损伤标志物NGAL和KIM-1可较好地预测新生儿窒息后AKI的发生。

Objective To study the early predictive value of urine neutrophil gelatinase-associated lipoprotein(NGAL)and kidney injury molecule-1(KIM-1)for acute kidney injury(AKI)in neonates with severe asphyxia.Method From January 2019 to June 2020,neonates with severe asphyxia admitted to our hospital within 6 hours after birth were enrolled in the study.The dynamic changes of urine NGAL and KIM-1 at admission,24 h,48 h and 1 w after birth were examined.Neonates were assigned into AKI group and non-AKI group according to the clinical practice guidelines for AKI issued by KDIGO(Kidney Disease:Improving Global Outcome).The sensitivity and specificity of NGAL and KIM-1 predicting AKI at different time points were evaluated using ROC curve and area under curve(AUC).Result According to the diagnostic criteria of neonatal AKI,9 cases were in the AKI group and 42 cases in the non-AKI group,and the incidence of AKI was 17.6%.Urine NGAL was significantly increased in AKI group at admission and 24 h after birth compared with the non-AKI group[(115.6±75.5)ng/ml vs.(49.8±29.0)ng/ml,(90.7±35.6)ng/ml vs.(55.6±30.7)ng/ml](P<0.05).No significant differences existed at 48 h and 1 w after birth between the two groups.At 24 h after birth,urine KIM-1 in the AKI group was significantly higher than the non-AKI group[(808.3±555.3)pg/ml vs.(318.4±234.0)pg/ml,P<0.05]and no significant differences existed between the two groups at admission,48 h and 1 w after birth.The AUC of NGAL predicting AKI at admission,24 h,48 h and 1w after birth were 0.804(95%CI 0.573~1.000),0.792(95%CI 0.580~1.000),0.732(95%CI 0.517~0.947)and 0.551(95%CI 0.371~0.730),respectively.The AUC of KIM-1 predicted AKI at admission,24 h,48 h and 1 w after birth was 0.860(95%CI 0.676~1.000),0.824(95%CI 0.655~0.993),0.768(95%CI 0.622~0.914),0.622(95%CI 0.392~0.852),respectively.Conclusion At admission,24 h and 48 h after birth,urine NGAL and KIM-1,as kidney injury markers,may predict the occurrence of AKI after severe neonatal asphyxia.