尿液胰岛素样生长因子结合蛋白-7与金属蛋白酶组织抑制剂-2在脓毒症急性肾损伤中的应用价值

The value of urinary insulin-like growth factor binding protein-7 and tissue inhibitor of metalloproteinase-2 in acute renal injury in sepsis

目的分析尿液胰岛素样生长因子结合蛋白-7(IGFBP-7)和金属蛋白酶组织抑制剂-2(TIMP-2)在脓毒症急性肾损伤(AKI)中的早期预测价值。方法选取2020年1月—2021年12月山西省人民医院急诊科监护室收治的脓毒症患者58例,并根据KDIGO的诊断标准分成脓毒症AKI组22例和非AKI组36例。分别在入组后0 h、24 h、48 h、72 h采集患者尿液及血液标本,并检测血肌酐(SCr)与尿IGFBP-7、TIMP-2水平。分析SCr、尿IGFBP-7、TIMP-2与脓毒症AKI的相关性。受试者工作特征曲线(ROC)分析SCr、尿IGFBP-7及TIMP-2在脓毒症早期急性肾损伤中的诊断价值。结果与非AKI组比较,AKI组各时点SCr、尿IGFBP-7、尿TIMP-2水平均升高,差异具有统计学意义(F/P=147.848/<0.001、330.849/<0.001、136.777/<0.001)。SCr与尿IGFBP-7、尿TIMP-2均呈正相关(r/P=0.680/<0.001,0.392/0.002),尿IGFBP-7与尿TIMP-2呈正相关(r/P=0.618/<0.001)。ROC曲线分析显示,SCr、尿IGFBP-7、尿TIMP-2及尿IGFBP-7联合TIMP-2预测脓毒症AKI的曲线下面积(AUC)分别为0.586、0.907、0.738、0.914,尿IGFBP-7、尿IGFBP-7联合TIMP-2优于SCr(Z/P=4.117/<0.001,4.196/<0.001);尿IGFBP-7、尿IGFBP-7联合TIMP-2优于尿TIMP-2(Z/P=2.663/0.008,3.378/0.008)。结论尿IGFBP-7、尿TIMP-2与尿IGFBP-7联合TIMP-2均可以作为早期预测脓毒症急性肾损伤发生的指标,且尿IGFBP-7、尿IGFBP-7联合TIMP-2的预测价值优于尿TIMP-2。

Objective To analyze the early predictive value of urinary insulin-like growth factor binding protein-7(IGFBP-7)and tissue inhibitor of metalloproteinase-2(TIMP-2)in acute renal injury(AKI)in sepsis.Methods Fifty-eight patients with sepsis admitted to the Emergency Department of Shanxi Provincial People's Hospital from January 2020 to December 2021 were selected and divided into a sepsis AKI group of 22 cases and a non AKI group of 36 cases according to KDIGO's diagnostic criteria.Collect urine and blood samples from patients at 0 h,24 h,48 h,and 72 h after enrollment,and detect levels of urine creatinine(SCr),IGFBP-7,and TIMP-2.Analyze the correlation between SCr,urinary IGFBP-7,TIMP-2,and sepsis AKI.The diagnostic value of receiver operating characteristic curve(ROC)analysis of SCr,urinary IGFBP-7,and TIMP-2 in early acute kidney injury in sepsis.Results Compared with the non AKI group,the levels of SCr,urinary IGFBP-7,and urinary TIMP-2 in the AKI group increased at all time points,with statistically significant differences(F/P=147.848/<0.001,330.849/<0.001,136.777/<0.001).SCR was positively correlated with urinary IGFBP-7 and urinary TIMP-2(r/P=0.680/<0.001,0.392/0.002),while urinary IGFBP-7 was positively correlated with urinary TIMP-2(r/P=0.618/<0.001).ROC curve analysis showed that the area under the curve(AUC)of SCr,urinary IGFBP-7,urinary TIMP-2,and urinary IGFBP-7/TIMP-2 in predicting sepsis AKI were 0.586,0.907,0.738,and 0.914,respectively.Urinary IGFBP-7 and urinary IGFBP-7/TIMP-2 were superior to SCr(Z/P=4.117/<0.001,4.196/<0.001).Urinary IGFBP-7 and urinary IGFBP-7/TIMP-2 are better than urinary TIMP-2(Z/P=2.663/0.008,3.378/0.008).Conclusion Urinary IGFBP-7,urinary TIMP-2,and urinary IGFBP-7/TIMP-2 can all be used as indicators for early prediction of acute kidney injury in sepsis,and the predictive value of urinary IGFBP-7 and urinary IGFBP-7/TIMP-2 is superior to urinary TIMP-2.