P-选择素、肾脏损伤分子1对肾病综合征并发急性肾损伤的早期诊断价值

Early diagnostic value of P-selectin and KIM-1 in nephrotic syndrome complicated with acute renal injury

目的探究P-选择素、肾脏损伤分子1(KIM-1)对肾病综合征并发急性肾损伤的诊断效能,分析肾病综合征并发急性肾损伤的相关因素。方法回顾性分析南京中医药大学附属南京医院2019年1月—2022年6月收治的100例肾病综合征患者的病历资料,根据病理活检结果分为急性肾损伤组和非急性肾损伤组。比较两组的一般资料、实验室指标(血清P-选择素、尿KIM-1、白蛋白、24 h尿量、24 h尿蛋白定量、血红蛋白、血肌酐、尿素氮、尿酸、D-二聚体、甘油三酯、总胆固醇)、入院用药史(利尿剂、质子泵抑制剂、抗血小板药);采用多因素一般Logistic回归分析肾病综合征并发急性肾损伤的相关因素;绘制ROC曲线,分析血清P-选择素、尿KIM-1对肾病综合征并发急性肾损伤的诊断效能。结果100例肾病综合征患者中合并急性肾损伤28例(28.00%),其中,肾小球轻微病变13例、IgA肾病8例、膜性肾病4例、增生性肾小球肾炎2例、节段性肾小球肾炎1例。72例(72.00%)肾病综合征患者未合并急性肾损伤。急性肾损伤组的血清P-选择素、尿KIM-1、血肌酐、尿素氮、尿酸、24 h尿蛋白定量和使用利尿剂占比均高于非急性肾损伤组(P<0.05),白蛋白、24 h尿量均低于非急性肾损伤组(P<0.05)。多因素一般Logistic回归分析结果显示,血清P-选择素升高[OR=4.464(95%CI:1.526,13.059)]、尿KIM-1升高[OR=3.963(95%CI:1.355,11.594)]、血肌酐升高[OR=4.059(95%CI:1.387,11.876)]、24 h尿量减少[OR=3.778(95%CI:1.291,11.051)]、24 h尿蛋白定量升高[OR=4.100(95%CI:1.401,11.996)]和白蛋白减少[OR=4.836(95%CI:1.653,14.147)]均是肾病综合征并发急性肾损伤的危险因素(P<0.05)。ROC曲线分析结果显示,血清P-选择素、尿KIM-1单独及联合诊断肾病综合征并发急性肾损伤的敏感性分别为64.29%(95%CI:0.441,0.806)、60.71%(95%CI:0.407,0.778)、82.14%(95%CI:0.624,0.932),特异性分别为76.39%(95%CI:0.646,0.852)、73.61%(95%CI:0.617,0.829)、79.17%(95%CI:0.676,0.875),曲线下面积分别为0.702、0.715、0.829。结论血清P-选择素、尿KIM-1可用于辅助诊断肾病综合征并发急性肾损伤,且诊断效能良好。

Objective To explore the diagnostic efficacy of P-selectin and KIM-1 in nephrotic syndrome with acute renal injury,and to analyze the related factors of nephrotic syndrome with acute renal injury.Methods Retrospective analysis was made on the clinical records of 100 patients with nephrotic syndrome admitted in our hospital from January 2019 to June 2022.According to the results of pathological biopsy,they were divided into acute renal injury group and non-acute renal injury group.To compare the demographic data,basic diseases,laboratory indicators,hospitalization medication history,and other data of the two groups,the related factors of nephrotic syndrome with acute renal injury was screen screened,and the diagnostic efficacy of serum P-selectin and urine KIM-1 for nephrotic syndrome with acute renal injury was analyzed.Results Among the 100 patients with nephrotic syndrome,28 patients were complicated with acute renal injury(28.00%),including 13 cases of mild glomerular disease,8 cases of lgA nephropathy,4 cases of membranous nephropathy,2 cases of proliferative glomerulonephritis,and 1 case of segmental glomerulonephritis.72 patients(72.00%)with nephrotic syndrome did not have acute renal injury.The proportion of serum P-selectin,urine KIM-1,serum creatinine,urea nitrogen,uric acid,24-hour urine protein,and diuretics in the acute renal injury group were higher than those in the non acute renal injury group(P<0.05),while albumin and 24-hour urine volume were lower than those in the non acute renal injury group(P<0.05).Serum P-selectin increased[OR=4.464(95%CI:1.526,13.059)],urinary KIM-1 increased[OR=3.963(95%CI:1.355,11.594)],serum creatinine increased[OR=4.059(95%CI:1.387,11.876)],decreased 24-hour urine volume[OR=3.778(95%CI:1.291,11.051)],24-hour urinary protein quantitative increased[OR=4.100(95%CI:1.401,11.996)],and decreased albumin[OR=4.836(95%CI:1.653,14.147)]were both risk factors for nephrotic syndrome complicated with acute renal injury(P<0.05).ROC analysis showed that the sensitivity of serum P-selectin and urine KIM-1 in single and combined diagnosis of nephrotic syndrome complicated with acute renal injury was 64.29%(95%CI:0.441,0.806),60.71%(95%CI:0.407,0.778),and 82.14%(95%CI:0.624,0.932),respectively;The specificity was 76.39%(95%CI:0.646,0.852),73.61%(95%CI:0.617,0.829),and79.17%(95%CI:0.676,0.875);The AUC was 0.702,0.715,and 0.829 respectively;The area under the curve(AUC)was 0.702,0.715,and 0.829,respectively.Conclusion Serum P-selectin and urine KIM-1 can be used to assist in the diagnosis of nephrotic syndrome with acute renal injury,and the diagnostic efficacy is good.