[尿中性粒细胞明胶酶相关脂质运载蛋白和尿白细胞介素-18在危重症患者急性肾损伤早期诊断中的应用]
[Urinary neutrophil gelatinase-associated lipocalin and urinary interleukin-18 in early diagnosis of acute kidney injury in critically ill patients].
作者信息
Zang Zhi-dong, Huang Ying-zi, Yang Yi, Guo Feng-mei, Qiu Hai-bo
机构信息
Department of Critical Care Medicine, Zhong-Da Hospital, Southeast University, Nanjing 210009, China.
出版信息
Zhonghua Nei Ke Za Zhi. 2010 May;49(5):396-9.
OBJECTIVE
To determine whether urinary neutrophil gelatinase-associated lipocalin (uNGAL) and urinary interleukin-18 (uIL-18) are early markers of acute kidney injury (AKI) in critically ill patients.
METHODS
Ninety-two critically ill patients were studied for one week after their enrollment into our hospital. During the study, 46 patients who met the RIFLE criteria were selected as AKI group and the remaining 46 patients without AKI taken as a control group. The two groups were matched for age, gender and illness severity. Urine samples were collected daily for one week. The receiver operating characteristic curve was used to evaluate the early diagnostic value of uNGAL, uIL-18 and serum creatinine (SCr).
RESULTS
As compared with the levels obtained 3 days before the diagnosis of AKI, the uNGAL levels in the AKI group increased significantly (P < 0.05), while uIL-18 and SCr levels did not change 2 days prior to the diagnosis of AKI (all P > 0.05). uNGAL and uIL-18 levels increased significantly (all P < 0.05), while SCr levels did not change 1 day prior to the diagnosis of AKI in the AKI group (P > 0.05). The levels of uNGAL, uIL-18 and SCr did not change significantly in the control group during the study period (all P > 0.05). Three days before the diagnosis of AKI, concentrations of uNGAL, uIL-18 and SCr were not the predictive of AKI. Two days before the diagnosis of AKI, the area under the curve (AUC) of uNGAL was 0.840 (95%CI 0.672 - 1.009, P < 0.05), which indicated that uNGAL was the predictive of AKI while uIL-18 and SCr were not. One day before the diagnosis of AKI, the AUC of uNGAL and uIL-18 were 0.830 (95%CI 0.711 - 0.950, P < 0.05) and 0.818 (95%CI 0.697 - 0.938, P < 0.05), indicating that uNGAL and uIL-18 were the predictive of AKI while SCr was not.
CONCLUSION
uNGAL and uIL-18 may be the early predictive markers of AKI in critically ill patients.
目的
确定尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）和尿白细胞介素-18（uIL-18）是否为危重症患者急性肾损伤（AKI）的早期标志物。
方法
92例危重症患者入院后接受为期一周的研究。研究期间，将46例符合RIFLE标准的患者选为AKI组，其余46例无AKI的患者作为对照组。两组在年龄、性别和疾病严重程度方面进行匹配。连续一周每天采集尿样。采用受试者工作特征曲线评估uNGAL、uIL-18和血清肌酐（SCr）的早期诊断价值。
结果
与AKI诊断前3天的水平相比，AKI组uNGAL水平显著升高（P<0.05），而uIL-18和SCr水平在AKI诊断前2天无变化（均P>0.05）。AKI组在AKI诊断前1天uNGAL和uIL-18水平显著升高（均P<0.05），而SCr水平无变化（P>0.05）。研究期间对照组uNGAL、uIL-18和SCr水平无显著变化（均P>0.05）。在AKI诊断前3天，uNGAL、uIL-18和SCr浓度均不能预测AKI。在AKI诊断前2天，uNGAL的曲线下面积（AUC）为0.840（95%CI 0.672 - 1.009，P<0.05），表明uNGAL可预测AKI，而uIL-18和SCr不能。在AKI诊断前1天，uNGAL和uIL-18的AUC分别为0.830（95%CI 0.711 - 0.950，P<0.05）和0.818（95%CI 0.697 - 0.938，P<0.05），表明uNGAL和uIL-18可预测AKI，而SCr不能。
结论
uNGAL和uIL-18可能是危重症患者AKI的早期预测标志物。
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