Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan.
J Crit Care. 2010 Dec;25(4):601-4. doi: 10.1016/j.jcrc.2010.04.002.
Acute renal failure (ARF) is the most important complication of rhabdomyolysis. Serial measurements of blood myoglobin might be useful for predicting rhabdomyolysis-induced ARF.
Thirty patients with rhabdomyolysis were examined. The causes of rhabdomyolysis were trauma, burns, and ischemia, among others. Serial blood myoglobin levels were measured by immunochromatography, and the peak value was determined. The relationship between blood myoglobin levels and the incidence of ARF was evaluated.
The median peak blood myoglobin level was 3335 ng/mL. Acute renal failure occurred in 12 patients (40%). Nine patients (30%) underwent renal replacement therapy. Peak creatine kinase and peak blood myoglobin levels in the ARF group were significantly higher than those in the non-ARF group. Three patients in the ARF group were treated with renal replacement therapy before occurrence of uremia because of extremely high levels of blood myoglobin (>10,000 ng/mL). Receiver operating characteristic analysis showed that the area under the curve for blood myoglobin that predicted ARF was 0.88, and the best cutoff value for blood myoglobin was 3865 ng/mL.
The peak value for blood myoglobin might be a good predictor of rhabdomyolysis-induced ARF. Early renal protective therapies should be considered for patients with rhabdomyolysis at high risk of ARF.
急性肾衰竭（ARF）是横纹肌溶解症最重要的并发症。连续检测血液肌红蛋白水平可能有助于预测横纹肌溶解症引起的急性肾衰竭。
共检测了 30 名横纹肌溶解症患者。横纹肌溶解症的病因包括创伤、烧伤和缺血等。采用免疫层析法连续检测血肌红蛋白水平，并确定峰值。评估血肌红蛋白水平与急性肾衰竭发生率之间的关系。
中位血肌红蛋白峰值为 3335ng/ml。12 名患者（40%）发生急性肾衰竭。9 名患者（30%）接受了肾脏替代治疗。急性肾衰竭组的峰值肌酸激酶和血肌红蛋白水平明显高于非急性肾衰竭组。3 名急性肾衰竭组患者因血肌红蛋白水平极高（>10000ng/ml）而在发生尿毒症前接受了肾脏替代治疗。受试者工作特征曲线分析显示，血肌红蛋白预测急性肾衰竭的曲线下面积为 0.88，血肌红蛋白最佳截断值为 3865ng/ml。
血肌红蛋白峰值可能是横纹肌溶解症引起急性肾衰竭的良好预测指标。对于横纹肌溶解症发生急性肾衰竭风险较高的患者，应考虑早期肾脏保护治疗。
