丝氨酸蛋白酶抑制剂A3在急性肾损伤诊断和预后预测中的价值

Diagnostic and prognostic value of SerpinA3 in acute kidney injury

目的:丝氨酸蛋白酶抑制剂A3(SerpinA3)在急性肾损伤(AKI)中的诊断及其预后价值。方法:前瞻性纳入广东省人民医院重症监护病房(ICU)收治的AKI患者(AKI组)93例和同期ICU非AKI患者(对照组)89例,用ELISA法检测患者的血液和尿液SerpinA3。收集患者临床资料及实验室检测数据。采用Spearman法分析血SerpinA3、尿SerpinA3与临床指标的相关性。对AKI患者随访28 d,用受试者工作曲线(ROC)和生存曲线对患者28 d存活及死亡进行分析。结果:AKI患者血SerpinA3[158250(107025,259575)ng/mL vs 125850(80775,196575)ng/mL,P<0.05]和尿SerpinA3[1618(678.8,5496)ng/mL vs 345.0(173.8,675.0)ng/mL,P<0.05]均较非AKI组显著增高。Spearman分析显示,尿SerpinA3与血清肌酐呈正相关(r=0.213,P<0.05)。尿SerpinA3在预测AKI患者的28 dd内病死率ROC曲线下面积为0.8,敏感度和特异度分别为72.73%和77.24%。Kaplan-Meier生存曲线分析结果显示,发生AKI时尿SerpinA3>5496 ng/mL的患者,28 d内生存率显著降低,预后较差。结论:SerpinA3对AKI诊断和预测患者预后有一定的价值,可作为AKI患者诊断和预后判断的生物学标志物。

Objective:To investigate the diagnosis of serine protease inhibitor A3(SerpinA3)in acute kidney injury(AKI)and its prognostic value.Methodology:Ninety-three patients with AKI admitted to the ICU of Guangdong Provincial People\s Hospital(AKI group)and 89 patients with non-AKI in the ICU during the same period(control group)were prospectively included.and blood SerpinA3 and urine SerpinA3 were detected by ELISA.Clinical data of the patients and the data of the laboratory tests were collected.The correlation between blood SerpinA3,urine SerpinA3,and clinical indexes was analyzed by Spearman\s method,and the independent risk factors for the occurrence of AKI were analyzed by binary logistic regression.Patients with AKI were followed up for 28 days,and those who survived and died at 28 days were analyzed using the subject's working curve(ROC)and the survival curve of patients with AKI.Results:Blood and urinary SerpinA3 levels,urinary SerpinA3 levels in AKI patients were[158250(107025,259575)ng/mL and 1618(678.8,5496)ng/mL,respectively;blood and urinary SerpinA3 in non-AKI patients were more than 125850(80775,196575),respectively;1618(678.8,5496)ng/mL than 345.0(173.8,675.0)ng/mL,AKI patients\blood and urinary SerpinA3 were more than both P<0.05]significantly higher than that of the non-AKI group,and both P<0.05.;Spearman correlation analysis showed a positive correlation between urinary SerpinA3 and blood creatinine(r=0.213,P<0.05).The area under the ROC curve for patients with AKI diagnosed by blood SerpinA3 and urine SerpinA3 was 0.606 and 0.885;respectively.The area under the ROC curve for urinary SerpinA3 in predicting intra-28-day morbidity and mortality in patients with AKI was 0.8,with a sensitivity and specificity of 72.73%and 77.24%,respectively.The results of the Kaplan-Meier survival curve analysis showed that patients who had urinary SerpinA3>5496 ng/mL at the time of the occurrence of AKI had a significantly lower survival rate within 28 days and a poorer prognosis.Conclusion:Urinary SerpinA3 is valuable as a biological marker for the diagnosis of AKI and for predicting the prognosis of patients with AKI.