尿生物标志物对机械通气患者急性肾损伤的预测

Urinary biomarkers predict acute kidney injury in patients with mechanical ventilation

目的分析早期尿生物标志物对机械通气患者急性肾损伤(acute kidney injury,AKI)发生的预测能力。方法收集2019年6月~9月在西安交通大学第一附属医院重症医学科(intensive care unit,ICU)接受有创机械通气24小时患者尿液,通过检测其中3种AKI新型生物标记物肝型脂肪酸结合蛋白(liver fatty acid binding protein,L-FABP)、组织金属蛋白酶抑制因子2(tissue inhibitor of metalloproteinase-2,TIMP-2)、胰岛素样生长因子结合蛋白7(insulin-like growth factor binding protein-7,IGFBP-7)的浓度,以期早期预测AKI的发生。结果31名有创机械通气患者,其中确诊为AKI的11名(35.48%);未确诊AKI的20名(64.52%),2组之间比较可见AKI组年龄更大、序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分更高、合并基础疾病大于3种所占比例较高(t/χ^(2)值分别为-5.670、-4.810、16.439,P值分别为0.003、0.001、<0.001);多因素Logistic回归分析结果显示有创机械通气是AKI的主要危险因素(OR=1.580,95%CI:1.124~1.739,P=0.009)。随机械通气时间延长,AKI发生风险增加;2组之间预后无差异;TIMP-2与IGFBP-7的乘积能够很好的预测AKI,ROC曲线下面积为0.803(95%CI:0.627~0.978,P=0.005),敏感性为0.750,特异性为0.895。结论尿生物标志物TIMP-2与IGFBP-7的乘积能够很好的预测机械通气患者AKI发生。

Objective To analyze the predictive ability of early urinary biomarkers for the occurrence of acute kidney injury(AKI)in patients with mechanical ventilation.Methods Urine samples were collected from the patients with invasive mechanical ventilation for 24 hours in the ICU of the First Affiliated Hospital,Xi’an Jiaotong University from June to September 2019.The concentrations of liver fatty acid binding protein(L-FABP),tissue inhibitor of metalloproteinasE2(TIMP-2)and insulin-like growth factor binding protein-7(IGFBP-7),the three novel biomarkers for AKI,were determined in the urine samples in order to predict the presence of AKI earlier.Results Of the 31 patients with invasive mechanical ventilation,11(35.48%)were diagnosed with AKI and 20(64.52%)without AKI.The rates of older age,higher score of sequential organ failure assessment(SOFA),and more than 3 kinds of underlying diseases were higher in the patients with AKI than those without AKI(t/χ^(2)=-5.670,-4.810 and 16.439 respectively,P=0.003,0.001 and<0.001 respectively).Logistic regression showed that invasive mechanical ventilation was the main risk factor for AKI(OR=1.58,95%CI 1.124~1.739,P=0.009).The risk of AKI increased with the duration of mechanical ventilation.There was no difference in prognosis between the patients with AKI and those without AKI.The product of TIMP-2 and IGFBP-7 predicted closely the presence of AKI;and the receiver operating characteristic(ROC)revealed that the AUC was 0.803(95%CI 0.627~0.978,P=0.005),the sensitivity was 0.750,and the specificity was 0.895.Conclusion The product of urinary biomarker TIMP-2 and IGFBP-7 can effectively predict the presence of AKI in patients with mechanical ventilation.