Askenazi David J, Koralkar Rajesh, Hundley Hayden E, Montesanti Angela, Parwar Pushkar, Sonjara Srdjan, Ambalavanan Namasivayam
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
J Pediatr. 2012 Aug;161(2):270-5.e1. doi: 10.1016/j.jpeds.2012.02.007. Epub 2012 Mar 16.
To identify urine biomarkers predictive of acute kidney injury (AKI) in infants admitted to level 2 and 3 neonatal intensive care units with birth weight >2000 g and 5-minute Apgar score ≤ 7.
A nested case-control study was performed comparing 8 candidate urine AKI biomarkers in infants with AKI (defined as a rise in serum creatinine of at least 0.3 mg/dL or a serum creatinine elevation ≥ 1.7 mg/dL persisting for 3 days) and 24 infants from the described cohort without AKI. Urine was analyzed for neutrophil gelatinase-associated lipocalin, osteopontin, cystatin C, albumin, β(2) microglobulin, epithelial growth factor, uromodulin (UMOD), and kidney injury molecule 1.
Compared with the infants without AKI, those with AKI had higher levels of urine cystatin C (1123 pg/mL [95% CI, 272-4635 pg/mL] vs 90 pg/mL [95% CI, 39-205 pg/mL]; P < .004; area under the receiver operating characteristic curve [AUC] = 0.82), lower levels of UMOD (11.0 pg/mL [95% CI, 5.7-21.4 pg/mL] vs 26.2 pg/mL [95% CI, 17.4-39.4 pg/mL]; P < .03; AUC = 0.77), and lower levels of epithelial growth factor (6.7 pg/mL [95% CI, 4.0-11.3 pg/mL] vs 17.4 pg/mL [95% CI, 12.7-23.8 pg/mL; P = .003; AUC = 0.82). Although the differences were not statistically significant, levels of urine neutrophil-associated gelatinase lipocalin, kidney injury molecule 1, and osteopontin trended higher in infants with AKI.
Urinary biomarkers can predict AKI in neonates admitted to level 2 and 3 neonatal intensive care units.
在出生体重>2000g且5分钟阿氏评分≤7分、入住二级和三级新生儿重症监护病房的婴儿中，确定可预测急性肾损伤（AKI）的尿液生物标志物。
进行了一项巢式病例对照研究，比较了发生AKI（定义为血清肌酐升高至少0.3mg/dL或血清肌酐升高≥1.7mg/dL持续3天）的婴儿与上述队列中24名未发生AKI的婴儿的8种候选尿液AKI生物标志物。分析尿液中的中性粒细胞明胶酶相关脂质运载蛋白、骨桥蛋白、胱抑素C、白蛋白、β2微球蛋白、上皮生长因子、尿调节素（UMOD）和肾损伤分子1。
与未发生AKI的婴儿相比，发生AKI的婴儿尿液胱抑素C水平更高（1123pg/mL[95%CI，272 - 4635pg/mL]对90pg/mL[95%CI，39 - 205pg/mL]；P<.004；受试者工作特征曲线下面积[AUC]=0.82），UMOD水平更低（11.0pg/mL[95%CI，5.7 - 21.4pg/mL]对26.2pg/mL[95%CI，17.4 - 39.4pg/mL]；P<.03；AUC = 0.77），上皮生长因子水平更低（6.7pg/mL[95%CI，4.0 - 11.3pg/mL]对17.4pg/mL[95%CI，12.7 - 23.8pg/mL；P =.003；AUC = 0.82）。虽然差异无统计学意义，但发生AKI的婴儿尿液中性粒细胞相关明胶酶脂质运载蛋白、肾损伤分子1和骨桥蛋白水平有升高趋势。
尿液生物标志物可预测入住二级和三级新生儿重症监护病房的新生儿的AKI。
