| 摘要: |
| 目的评估血清胱抑素C（sCysC）、尿N-乙酰-β-D-氨基葡萄糖苷酶（uNAG）和尿白蛋白/肌酐比值（uACR）在急性肾损伤（AKI）检测和预后预测的诊断价值及最优组合。方法收集ICU135例危重患者，采用肾脏经疾病改善整体预后肌酐标准来确定AKI患者，包括需行肾脏替代治疗（RRT）的患者。由急性生理学和慢性健康评估（APACHE）II分，器官衰竭评估（SOFA）评分衡量病情严重程度。使用Spearman相关分析各生物标志物之间的相关性，采用回归分析评估收治EICU后sCysC、uNAG和uACR的浓度与AKI最高分期和RRT治疗之间的相关性，并且运用ROC曲线比较sCysC、uNAG和uACR以及不同组合联合检测对于AKI的诊断效能。结果符合入组标准的患者135例，其中58例发生AKI，其中合并有肾功能不全和脓毒症的比例以及ICU停留时间和使用RRT疗法明显高于非AKI组（均P＜0.05），两组间删失率无统计学差异（P＞0.05），收治ICU后24h再次评估，之前无AKI的18例（31%）患者均发生不同程度的肾损伤（P＜0.01）。需RRT治疗的患者26例（44.8%）较入院时明显增多（P＜0.01）。两组相比3种生物标志物均有统计学差异（均P＜0.01），sCysC与uNAG（r=0.731，P＜0.01），sCysC与uACR（r=0.70，P＜0.01），uNAG与uACR（r=0.651，P＜0.01）之间均呈正相关。其中sCysC与AKI各个期和需要RRT治疗存在相关性（P＜0.05）。ROC曲线结果显示sCysC的AUC高于uNAG和uACR，分别为0.972、0.842、0.869（P＜0.01）。sCysC+uNAG组的AUC-ROC值为0.973，均高于单个生物标志物和其他两个联合组（P＜0.01）。sCysC+uNAG组比单个生物标志物或其他两个组显示出更高的特异度和灵敏度（分别为0.99和0.82）。结论sCysC与AKI的最坏分期和需要RRT治疗之间具有最强的独立相关性。sCysC和uNAG的组合可以显著增加AKI的诊断效能。 |
| 关键词: 急性肾损伤 肾标志物 血清胱抑素 C 尿 N- 乙酰 -β-D- 氨基葡萄糖苷酶 尿白蛋白 / 肌酐比值 |
| DOI：10.12056/j.issn.1006-2785.2018.40.11.2017-1716 |
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| Diagnostic value of serum cystatin C and renal tubular injury markers in acute renal injury |
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Ninghai First Hospital
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| Abstract: |
| Objective To examine the value of serum cystatin C(sCysC), urinary N-acetyl-β-D-glucosaminidase (uNAG) and urinary albumin/creatinine ratio (uACR) and their combination in the diagnosis and prognosis of acute renal injury (AKI). Methods A total of 135 critically ill patients in emergency intensive unit (ICU) were recruited, AKI patients were identified using the kidney disease-improving overall prognostic creatinine criteria, including those requiring renal replacement therapy (RRT). The severity of illness was measured by the Acute Physiology and Chronic Health Assessment (APACHEII) score and Organ Failure Assessment (SOFA) score. Spearman correlation test was used to analyze the correlation between biomarkers. Regression analysis was used to evaluate the correlation between sCysC, uNAG, uACR levels and the highest stage of AKI and RRT treatment; and ROC curves were used to evaluate the application of sCysC, uNAG, uNAR, uACR and different combinations for the diagnosis of AKI. Results Among 135 patients, there were 58 cases of AKI; the incidence of renal insufficiency and sepsis,
the length of ICU stay and RRT therapy in AKI patients were significantly higher than those in non-AKI group (all P＜0.05). There
was no significant difference in censored rate between two groups (P ＞0.05). After 24h of ICU admission, the renal impairment occurred in 18 cases in patients without AKI at admission (31% ); 26 patients (44.8% ) required RRT treatment, which were significantly more than those at admission (P=0.001). There were significant differences in levels of these biomarkers between two groups (P＜0.01). The sCysC was positively correlated with uNAG (r=0.731, P＜0.01), uACR (r=0.70, P＜0.01) and uNAG was significantly correlated with uACR (r=0.651, P＜0.01) . The sCysC and AKI levels were correlated with the severity of AKI and the needs of RRT (P＜0.05). The ROC analysis showed that the AUC-ROC of sCysC was higher than that of uNAG and uACR (0.972 vs. 0.842 and 0.869, P＜0.01).The AUC-ROC value of the sCysC+uNAG was 0.973, which was higher than that of the single biomarker and the combinations with other two markers (P ＜0.01). The sCysC+uNAG group showed higher specificity and sensitivity (0.99 and 0.82, respectively) than either a single biomarker or the combinations with other two biomarkers. Conclusion sCysC is strongly correlated with the severity of AKI the need for RRT treatment; the combination of sCysC and uNAG can signifi-
cantly increase the diagnostic performance of AKI. |
| Key words: AKI Renal biomarker sCysC uNAG uACR |
