肾损伤分子-1与胱抑素C对老年原发性肾病综合征所致急性肾损伤早期诊断价值

Value of renal injury molecule-1 and cystatin C in the early diagnosis of acute kidney injury caused by primary nephrotic syndrome in the elderly

目的探究肾损伤分子-1(KIM-1)与胱抑素C(CysC)对老年原发性肾病综合征(PNS)所致急性肾损伤(AKI)早期诊断价值。方法选取2016年3月—2021年2月如皋市中医院收治的86例老年PNS患者为研究对象,统计AKI发生情况。对比发生组和未发生组临床资料。Logistic多因素回归分析影响PNS发生AKI的危险因素。制作受试者工作特征曲线(ROC),分析联合检测血清KIM-1、CysC对PNS所致AKI的诊断效能。结果本研究中PNS患者AKI的发生率为31.40%。发生组尿蛋白量、白蛋白(Alb)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、白细胞介素-18(IL-18)、血肌酐(Scr)、估算肾小球滤过率(eGFR)、尿素氮(BUN)、血清KIM-1、CysC水平均高于未发生组(P<0.05)。Logistic回归分析结果显示,eGFR、血清KIM-1、CysC均为PNS患者发生AKI的危险因素(OR=3.022、2.782、3.343,P<0.05)。ROC分析显示,血清KIM-1、CysC诊断PNS患者所致AKI的最佳截断点分别为1.71 ng/L、2.98 mg/L,两者联合的特异度为98.31%,高于血清KIM-1、CysC单独进行预测的特异度,且血清KIM-1、CysC两者联合诊断PNS患者所致AKI的AUC为0.893,高于血清KIM-1、CysC单独诊断的AUC(Z=2.724,P=0.006;Z=2.053,P=0.048)。结论血清KIM-1、CysC两者联合检测对PNS所致AKI的诊断效能较高,可作为评估PNS所致AKI发生的重要参考指标。

Objective To explore the value of kidney injury molecule-1(KIM-1)and cystatin C(CysC)in the early diagnosis of acute kidney injury(AKI)caused by senile primary nephrotic syndrome(PNS).Methods A total of 86 elderly patients with PNS admitted to our hospital from March 2016 to February 2021 were selected as the research objects,and the incidence of AKI was counted.Compared the clinical data of the occurrence group and the non-occurring group.Logistic multivariate regression analysis of the risk factors of AKI in PNS.A receiver operating characteristic curve(ROC)was made to analyze the diagnostic efficacy of the combined detection of serum KIM-1 and CysC for AKI caused by PNS.Results In this study,the incidence of AKI in PNS patients was 31.40%.Occurrence group urine protein content,albumin(Alb),acute physiology and chronic health scoring system II(APACHE II)score,interleukin-18(IL-18),blood creatinine(Scr),estimated glomerular filtration rate(eGFR),urea nitrogen(BUN),serum KIM-1,CysC levels were higher than those in the non-occurring group(P<0.05).Logistic regression analysis showed that eGFR,serum KIM-1,and CysC were all risk factors for AKI in PNS patients(OR=3.022,2.782,3.343;P<0.05).ROC analysis showed that the best cut-off points of serum KIM-1 and CysC for the diagnosis of AKI in patients with PNS were 1.71 ng/L and 2.98 mg/L,respectively.The specificity of the combination of the two was 98.31%,which was higher than that of serum KIM-1 and CysC.The specificity of CysC alone for prediction,and the combination of serum KIM-1 and CysC in the diagnosis of AKI in patients with PNS has an AUC of 0.893,which is higher than the AUC diagnosed by serum KIM-1 and CysC alone(Z=2.724,P=0.006;Z=2.053,P=0.048).Conclusion The combined detection of serum KIM-1 and CysC has a high diagnostic efficiency for AKI caused by PNS,and it can be used as an important reference index for evaluating the occurrence of AKI caused by PNS.