血清胱抑素C和视黄醇结合蛋白在生后48小时内对新生儿急性肾损伤的预测价值

Predictive value of serum cystatin C and retinol binding protein in neonatal acute kidney injury within 48 hours after birth

目的分析血清胱抑素C(Cys-C)和视黄醇结合蛋白(RBP)在出生后48 h内对新生儿急性肾损伤(AKI)的预测价值,指导临床早期发现新生儿AKI。方法选取2017年7月—2018年6月出生后48 h内入住本院新生儿重症监护病房的新生儿为研究对象进行前瞻性研究。根据出生后48 h内是否发生AKI,分为AKI组和非AKI组,检测患儿出生后48 h内血清Cys-C及RBP水平。以多重线性回归分析评估血清Cys-C、RBP与AKI的关系,用受试者工作特征曲线(ROC)及曲线下面积(AUC)评价血清Cys-C、RBP对新生儿AKI的预测价值。结果研究期间共纳入258例新生儿,AKI组有106例,非AKI组有152例。AKI组中足月儿有39例,早产儿有67例,非AKI组中足月儿有58例,早产儿有94例。多重线性回归分析显示,足月儿中AKI的患儿胎龄、出生体重、Apgar评分、胎盘、脐带及血清RBP水平与非AKI组无统计学差异,而血清Cys-C水平高于非AKI组,差异有统计学意义(P<0.001),足月儿血清Cys-C预测AKI的AUC值为0.87(95%CI 0.79～0.95,P<0.001)。早产儿中AKI的患儿胎龄、出生体重、Apgar评分、胎盘及脐带与非AKI组无统计学差异,而血清Cys-C、RBP水平与非AKI组差异有统计学意义(P<0.001),早产儿血清Cys-C及RBP预测AKI的AUC值分别为0.80(95%CI 0.72～0.89,P<0.001)和0.77(95%CI 0.67～0.86,P<0.001)。结论血清RBP在预测新生儿AKI的早期诊断中的价值有待进一步研究,而血清Cys-C作为预测新生儿AKI的指标具有较高的可靠性,在指导临床早期发现新生儿AKI中具有重要价值。

Objective To analyze the predictive value of serum cystatin C(Cys-C)and retinol-binding protein(RBP)for neonatal acute kidney injury(AKI)within 48 hours after birth,and to guide the early detection of neonatal AKI.Methods A prospective study was performed on neonates who were admitted to the neonatal intensive care unit of the hospital within 48 hours of their birth from July 2017 to June 2018.According to whether AKI occurred within 48 hours after birth,they were divided into AKI group and non-AKI group,and serum Cys-C and RBP were detected within 48 hours after birth.Multiple linear regression analysis was used to evaluate the relationship between serum Cys C,RBP and AKI after adjusting for confounding factors.The predictive value of serum Cys C and RBP for neonatal AKI was evaluated by receiver operating characteristic(ROC)curve and area under the curve(AUC).Results A total of 258 neonates were included during the study period,including 106 in the AKI group and 152 in the non-AKI group.There were 39 full-term infants and 67 in preterm infants in the AKI group.There were 58 full-term infants and 94 in preterm infants in the non-AKI group.Multiple linear regression analysis showed that the gestational age,birth weight,Apgar score,RBP levels in placenta,umbilical cord and serum of in-term infants in AKI group were not significantly different from those in the non-AKI group.Serum Cys-C levels of AKI grou were higher than the control group,and the difference was statistically significant(P<0.001).Serum Cys-C level predicted AKI with an AUC value of 0.87(95%CI:0.79-0.95,P<0.001).There were no significant differences in gestational age,birth weight,Apgar score,placenta and umbilical cord between the preterm infants with AKI in AKI group and the non-AKI group.The differences of serum Cys-C and RBP levels between AKI group and non-AKI group were statistically significant(P<0.001).The AUC values of serum Cys-C and RBP levels predicted AKI for preterm infants were 0.80(95%C10.72-0.89,P<0.001)and 0.77(95%C1 0.67-0.86,P<0.001).Conclusions The value of serum RBP in predicting the early diagnosis of AKI in preterm infants needs further study.Serum Cys-C could be used as a biologically independent indicator for predicting neonatal AKI sensitivity,and is of great value in guiding early detection of neonatal AKI.