尿TIMP-2、IGFBP7对危重症AKI患者CRRT脱机成功的预测价值

Predictive value of urine TIMP-2 and IGFBP7 for the success of CRRT weaning in critically ill patients with AKI

目的探讨尿液金属蛋白酶抑制剂-2(TIMBP-2)×人胰岛素样生长因子结合蛋白7(IGFBP7)对危重症急性肾损伤(AKI)患者行持续性肾脏替代治疗(CRRT)脱机成功的预测价值。方法选取该院重症监护室2020年6月至2021年3月危重症AKI行CRRT后脱机的患者57例为研究对象,记录一般临床资料。分别在第1次启动CRRT前1 d及脱机前后3 d留取静脉血及尿液标本,进行24 h尿量测定,血清肌酐、尿素氮及TIMBP-2×IGFBP7检测。根据患者是否脱机成功分为CRRT脱机成功组(34例),CRRT转血液透析组(6例),CRRT重启组(17例),观察结果并进行分析。结果3组患者的性别、年龄、并发症、序贯性器官功能衰竭评分、急性生理与慢性健康评分比较差异无统计学意义(P>0.05);第1次启动CRRT前1 d的尿量、血清肌酐、尿素氮水平差异无统计学意义(P>0.05)。在脱机前3 d CRRT脱机成功组患者的尿TIMP-2×IGFBP7比其他两组低,差异有统计学意义(P<0.05),各组尿量及血清肌酐、尿素氮水平比较差异无统计学意义(P>0.05)。尿TIMP-2×IGFBP7的受试者工作特征曲线下面积为0.822,最佳临界值为1.2 ng/mL 2,灵敏度为0.794,特异度为0.762。结论尿TIMP-2×IGFBP7对危重症AKI患者CRRT脱机成功有早期预测价值,可作为早期预警甚至诊断指标。

Objective To investigate the predictive value of urinary metalloproteinase inhibitor-2(TIMBP-2)×human insulin-like growth factor binding protein 7(IGFBP7)for the successful weaning of continuous renal replacement therapy(CRRT)in critically ill acute kidney injury(AKI)patients.Methods A total of 57 critically ill AKI patients who were taken weaned after CRRT treatment in the intensive care unit of the hospital from June 2020 to March 2021 were selected as the research objects,and general clinical data were recorded.Venous blood and urine samples were collected 1 d before the first CRRT treatment and 3 d before and after weaning.The urine volume was measured for 24 h,and the serum creatinine,urea nitrogen and TIMBP-2×IGFBP7 were tested.According to whether the patients were successfully weaning,they were divided into CRRT weaning success group(34 cases),CRRT to hemodialysis group(6 cases),and CRRT restart group(17 cases).The results were observed and analyzed.Results There were no significant differences in gender,age,complications,sequential organ failure scores,acute physiology and chronic health scores among the three groups(P<0.05).There were no significant differences in urine volume,serum creatinine,and urea nitrogen levels 1 d before the first CRRT(P<0.05).The urine TIMP-2×IGFBP7 of the CRRT weaning success group was lower than the other two groups 3 d before weaning,and the difference was statistically significant(P<0.05).There were no statistically significant differences in urine volume and serum creatinine,urea nitrogen levels in each group(P>0.05).The area under the receiver operating characteristic curve of urine TIMP-2×IGFBP7 was 0.822,the best cut-off value was 1.2 ng/mL 2,the sensitivity was 0.794,and the specificity was 0.762.Conclusion Urinary TIMP-2×IGFBP7 has an early predictive value for the success of CRRT weaning in critically ill AKI patients,and can be used as an early warning or even diagnostic indicator.