尿TIMP-2与IGFBP7的乘积对重症急性胰腺炎相关性急性肾损伤的早期预测价值

Early Predictive Value of the Product of Urinary TIMP-2 and IGFBP7 for Severe Acute Pancreatitis-Related Acute Kidney Injury

目的探究尿基质金属蛋白酶抑制因子-2(TIMP-2)与胰岛素样生长因子结合蛋白7(IGFBP7)的乘积对重症急性胰腺炎(SAP)相关性急性肾损伤(AKI)的早期预测价值。方法选取2018年3月至2021年3月新乡医学院第一附属医院收治的93例SAP患者为研究对象,根据患者是否发生AKI分为AKI组(26例)和非AKI组(67例)。采用酶联免疫吸附法(ELISA)检测患者尿液中TIMP-2和IGFBP7水平;采用多因素logistic回归分析影响SAP患者发生AKI的危险因素;通过受试者工作特征(ROC)曲线分析SAP患者急性胰腺炎严重程度床边指数(Bisap)评分、尿液中TIMP-2与IGFBP7的乘积对发生AKI的预测价值。结果与非AKI组相比,AKI组患者Bisap评分、D-二聚体、降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、TIMP-2与IGFBP7的乘积均上升,血钙水平降低(P<0.05)。AKI患者尿液TIMP-2与IGFBP7的乘积随AKI分级增加而上升(P<0.05)。Pearson相关性分析结果显示,AKI患者尿液TIMP-2与IGFBP7的乘积与Bisap评分、D-二聚体、PCT、hs-CRP均呈正相关(P<0.05),与血钙呈负相关(P<0.05)。多因素logistic回归分析结果显示,Bisap评分、TIMP-2与IGFBP7的乘积是影响SAP相关性AKI发生的危险因素(P<0.05)。ROC曲线分析结果显示,尿液TIMP-2与IGFBP7的乘积预测SAP患者发生AKI的曲线下面积(AUC)为0.923,高于Bisap评分预测的AUC(P<0.05)。结论SAP相关性AKI患者尿TIMP-2与IGFBP7的乘积异常升高,其高水平是SAP患者发生AKI的危险因素,且对发生AKI具有一定的预测价值。

Objective To explore the early predictive value of the product of urinary tissue inhibitor of metalloproteinase-2(TIMP-2)and insulin-like growth factor binding protein 7(IGFBP7)for severe acute pancreatitis(SAP)-related acute kidney injury(AKI).Methods Ninety-three SAP patients admitted to the First Affiliated Hospital of Xinxiang Medical College from March 2018 to March 2021 were selected as the research objects.According to whether the patients had AKI,they were divided into 26 cases in the AKI group and 67 cases in the non-AKI group.Enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of TIMP-2 and IGFBP7 in the urine.Multivariate logistic regression analysis was used to analyze the risk factors of AKI in SAP patients.Receiver operator characteristic(ROC)curve was used to analyze the predictive value of bedside index for severity in acute pancreatitis(Bisap)score and the product of urinary TIMP-2 and IGFBP7 of SAP patients for the occurrence of AKI.Results Compared with the non-AKI group,the Bisap score,D-dimer,procalcitonin(PCT),hypersensitive C-reactive protein(hs-CRP),the product of urinary TIMP-2 and IGFBP7 in the AKI group were increased,and the blood calcium level was decreased(P<0.05).The product of urinary TIMP-2 and IGFBP7 of AKI patients increased with the increase of AKI grade(P<0.05).The results of Pearson correlation analysis showed that the product of urinary TIMP-2 and IGFBP7 of AKI patients was positively correlated with Bisap score,D-dimer,PCT,and hs-CRP(P<0.05),and was negatively correlated with serum calcium(P<0.05).The results of multivariate Logistic regression analysis showed that Bisap score and the product of urinary TIMP-2 and IGFBP7 were risk factors affecting the occurrence of SAP-related AKI(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of the product of urinary TIMP-2 and IGFBP7 predicting AKI in SAP patients was 0.923,which was higher than that predicted by Bisap score(P<0.05).Conclusion The product of urinary TIMP-2 and IGFBP7 in SAP-related AKI patients is abnormally elevated.The high level is a risk factor for AKI in SAP patients,and it has certain predictive value for the occurrence of AKI.