尿NGAL、KIM-1联合APACHEⅡ评分对脓毒症急性肾损伤诊断及预后的价值

The value of NGAL,KIM-1 and APACHE Ⅱ score in diagnosis and prognosis of acute renal injury in sepsis

目的:探讨尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子-1(KIM-1)联合急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分对脓毒症急性肾损伤(AKI)诊断及预后的价值。方法:选取我院收治的脓毒症患者154例,根据其是否发生AKI分为AKI组(n=53)和非AKI组(n=101)。53例AKI患者根据其28d的生存情况,分为存活组(n=36)和死亡组(n=17)。采用酶联免疫吸附法测定各组尿NGAL、KIM-1水平,并记录其APACHEⅡ评分。应用受试者工作特征(ROC)曲线评价尿NGAL、KIM-1及APACHEⅡ评分对AKI诊断及预后的价值。结果:AKI组尿NGAL[(753.28±540.36)pg/ml vs(456.50±381.42)ng/ml]、KIM-1[(46.37±9.12)pg/ml vs(20.54±6.34)pg/ml]及APACHEⅡ评分[(22.14±7.50)分vs(16.12±6.13)分]均明显高于非AKI组(P<0.05)。死亡组尿NGAL[(957.50±716.35)ng/ml vs (582.30±427.40)ng/ml]、KIM-1[(63.84±12.32)pg/ml vs(30.26±7.15)pg/ml]及APACHEⅡ评分[(27.60±8.24)分vs(18.37±6.38)分]均明显高于存活组(P<0.05)。ROC曲线分析显示,尿NGAL、KIM-1、APACHEⅡ评分诊断AKI的最佳截值分别为614.28ng/ml,35.78pg/ml,19.58分,三者联合诊断AKI的敏感度(95.0%)和特异度(87.0%)较好;尿NGAL、KIM-1、APACHEⅡ评分预测AKI患者死亡的最佳截值分别为793.42ng/ml,49.13pg/ml,24.63分,三者联合预测AKI患者死亡的敏感度(97.4%)和特异度(88.2%)较好。结论:尿NGAL及KIM-1是预测脓毒症患者发生AKI及预后的有效指标,与APACHEⅡ评分联合有助于提高AKI诊断和预后评估的准确性。

Objective:The value of urinary neutrophil gelatinase related lipid carrier protein(NGAL),renal injury molecule-1(KIM-1)combined with acute physiology and chronic health status score system(APACHE Ⅱ)score on the diagnosis and prognosis of acute kidney injury(AKI)of sepsis.Method:One hundred and fifty-four patients with sepsis were selected from the third People’s Hospital of Hainan Province.They were divided into AKI group(n=53)and non AKI group(n=101)according to whether they had AKI.53 patients with AKI were divided into survival group(n=36)and death group(n=17)according to their 28 days survival.The levels of NGAL and KIM-1in urine of each group were measured by enzyme linked immunosorbent assay(ELISA),and the APACHE Ⅱscore was recorded.Application of receiver operating characteristic(ROC)curve to evaluate urinary NGAL,KIM-1and APACHE Ⅱscores in diagnosis and prognosis of AKI.Correlation analysis of urinary NGAL and KIM-1levels and APACHE Ⅱscore in AKI patients by Pearson correlation analysis.Result:The urine NGAL(753.28±540.36 vs 456.50±381.42,ng/ml),KIM-1(46.37±9.12 vs 20.54±6.34,pg/ml)and APACHE Ⅱ score(22.14±7.50 vs 16.12±6.13,score)in AKI group were significantly higher than those in non AKI group(P<0.05).The urine NGAL(957.50±716.35 vs 582.30±427.40,ng/ml),KIM-1(63.84±12.32 vs 30.26±7.15,pg/ml)and APACHE Ⅱscore(27.60±8.24 vs 18.37±6.38,score)in the death group were significantly higher than those in the survival group(P<0.05).The ROC curve analysis showed that the best cross-sectional value of NGAL,KIM-1and APACHEⅡscores in the diagnosis of AKI were 614.28ng/ml,35.78pg/ml,19.58 score,and the sensitivity(95.0%)and specificity(87.0%)of the three combined diagnostic AKI were better.The best cut-off values of urinary NGAL,KIM-1and APACHE Ⅱ scores in predicting the death of AKI patients were 793.42ng/ml,49.13pg/ml,24.63 score,and the sensitivity(97.4%)and specificity(88.2%)of the three combined prediction of the death of AKI were better.Correlation analysis showed that urinary NGAL and KIM-1levels in AKI patients were positively correlated with APACHEⅡscore(r=0.794,r=0.730,P<0.01).Conclusion:Urine NGAL and KIM-1are effective indicators for predicting AKI and prognosis in patients with sepsis.Combined with APACHE Ⅱscore can help improve the accuracy of AKI diagnosis and prognosis evaluation.