Suksamai Anuchit, Khaoprasert Sanpolpai, Chaiprasert Amnart, Chirapongsathorn Sakkarin
Division of Gastroenterology and Hepatology, Department of Medicine Phramongkutklao Hospital and College of Medicine Bangkok Thailand.
Division of Nephrology, Department of Medicine Phramongkutklao Hospital and College of Medicine Bangkok Thailand.
JGH Open. 2025 Apr 22;9(4):e70168. doi: 10.1002/jgh3.70168. eCollection 2025 Apr.
Urinary biomarkers may predict acute kidney injury (AKI) in cirrhosis with ascites in a moderate volume paracentesis setting.
The study aimed to assess the risk and consequence of AKI and its progression in patients with decompensated cirrhosis undergoing paracentesis using a urine test measuring tissue inhibitor of metalloproteinases-2 (TIMP2) and insulin-like growth factor-binding protein 7 (IGFBP7).
A randomized, controlled trial was performed. All outpatients with decompensated cirrhosis with ascites and diuretic complications were enrolled and randomized into 3 and 5 L paracentesis groups. Serial urine samples were analyzed for TIMP2. IGFBP7 concentration before and after paracentesis.
A total of 90 patients with decompensated cirrhosis were consecutively enrolled during the study period. After screening, 29 patients were enrolled in the 3-L paracentesis group, and 25 patients were enrolled in the 5-L paracentesis group. The mean of the MELD score was 8 ± 1.2. Urine TIMP2.IGFBP7 > 2, rising urine TIMP2, and rising urine TIMP2/urine Cr were shown in patients within the 5-L group for 48% ( = 0.015), 32% ( = 0.049), and 76% ( = 0.010) respectively, indicating a higher incidence of renal tubular injury markers in this group. Urine TIMP2.IGFBP7/1000 > 2 was statistically significant to predict a hemodynamic event ( = 0.002).
In cirrhotic patients with ascites undergoing paracentesis, a 5-L paracentesis volume was associated with a higher incidence of renal tubular injury markers. The national clinical registration number was TCTR20191116003.
在中等量腹腔穿刺放腹水的情况下，尿生物标志物可能预测肝硬化腹水患者的急性肾损伤（AKI）。
本研究旨在通过检测尿金属蛋白酶组织抑制剂-2（TIMP2）和胰岛素样生长因子结合蛋白7（IGFBP7），评估失代偿期肝硬化患者腹腔穿刺放腹水时AKI的风险、后果及其进展情况。
进行了一项随机对照试验。纳入所有伴有腹水和利尿剂并发症的失代偿期肝硬化门诊患者，并随机分为3L和5L腹腔穿刺放腹水组。对腹腔穿刺放腹水前后的系列尿样进行TIMP2和IGFBP7浓度分析。
在研究期间共连续纳入90例失代偿期肝硬化患者。筛选后，29例患者纳入3L腹腔穿刺放腹水组，25例患者纳入5L腹腔穿刺放腹水组。平均终末期肝病模型（MELD）评分为8±1.2。5L组患者中，分别有48%（P=0.015）、32%（P=0.049）和76%（P=0.010）出现尿TIMP2·IGFBP7>2、尿TIMP2升高和尿TIMP2/尿肌酐升高，表明该组肾小管损伤标志物的发生率较高。尿TIMP2·IGFBP7/1000>2对预测血流动力学事件具有统计学意义（P=0.002）。
在进行腹腔穿刺放腹水的肝硬化腹水患者中，5L的放腹水量与肾小管损伤标志物的较高发生率相关。国家临床注册号为TCTR20191116003。
