尿中[TIMP-2]⋅[IGFBP7]、L-FABP和NGAL水平对预测日本患者社区获得性急性肾损伤的效能：一项单中心前瞻性队列研究。

Efficacy of urinary [TIMP-2]⋅[IGFBP7], L-FABP, and NGAL levels for predicting community-acquired acute kidney injury in Japanese patients: a single-center, prospective cohort study.

作者信息

Inotani Satoshi, Kashio Takeshi, Osakabe Yuki, Matsumoto Tatsuki, Nagao Yoshiki, Ishihara Masayuki, Iwata Hideki, Mitani Keita, Hatakeyama Yutaka, Horino Taro

机构信息

Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.

Department of Paediatrics, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.

出版信息

Clin Exp Nephrol. 2025 Feb 21. doi: 10.1007/s10157-025-02641-8.

DOI:10.1007/s10157-025-02641-8

PMID:39982587

Abstract

BACKGROUND

The combination of urinary tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) ([TIMP-2]⋅[IGFBP7]) has emerged as a strong predictor of acute kidney injury (AKI), which is associated with poor outcomes. However, most studies have focused on non-Asian populations, and comparisons of [TIMP-2]⋅[IGFBP7] with other AKI biomarkers in Asian populations have not been performed. Furthermore, no study has examined the efficacy of [TIMP-2]⋅[IGFBP7] for predicting community-acquired AKI.

METHODS

We prospectively enrolled adult patients at Kochi Medical School Hospital in Kochi, Japan, and performed a receiver-operating characteristic (ROC) curve analysis to assess the ability of [TIMP-2]⋅[IGFBP7], neutrophil gelatinase-associated lipocalin (NGAL), and liver fatty acid-binding protein (L-FABP) measured at the time of admission to predict AKI.

RESULTS

Of the 170 enrolled patients, 40 (23.5%) developed AKI. Risk factors for AKI development were male sex, history of hypertension, low albumin levels, and high [TIMP-2]⋅[IGFBP7] and NGAL levels. The ROC curve analysis showed that the area under the ROC curve (AUC) of [TIMP-2]•[IGFBP7] for predicting AKI was 0.804 (95% confidence interval [CI], 0.728-0.880); however, the AUCs of L-FABP and NGAL were 0.688 (95% CI, 0.594-0.782) and 0.726 (95% CI, 0.639-0.813), respectively.

CONCLUSION

Urinary [TIMP-2]⋅[IGFBP7] is a good predictor of community-acquired AKI.

摘要

背景

尿金属蛋白酶组织抑制剂2（TIMP - 2）与胰岛素样生长因子结合蛋白7（IGFBP7）的组合（[TIMP - 2]⋅[IGFBP7]）已成为急性肾损伤（AKI）的有力预测指标，而AKI与不良预后相关。然而，大多数研究集中在非亚洲人群，尚未对亚洲人群中[TIMP - 2]⋅[IGFBP7]与其他AKI生物标志物进行比较。此外，尚无研究检验[TIMP - 2]⋅[IGFBP7]预测社区获得性AKI的效能。

方法

我们在日本高知市高知医学院附属医院前瞻性纳入成年患者，并进行了受试者工作特征（ROC）曲线分析，以评估入院时测定的[TIMP - 2]⋅[IGFBP7]、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和肝脏脂肪酸结合蛋白（L - FABP）预测AKI的能力。

结果

在纳入的170例患者中，40例（23.5%）发生了AKI。AKI发生的危险因素为男性、高血压病史、低白蛋白水平以及高[TIMP - 2]⋅[IGFBP7]和NGAL水平。ROC曲线分析显示，[TIMP - 2]•[IGFBP7]预测AKI的ROC曲线下面积（AUC）为0.804（95%置信区间[CI]，0.728 - 0.880）；然而，L - FABP和NGAL的AUC分别为0.688（95% CI，0.594 - 0.782）和0.726（95% CI，0.639 - 0.813）。