CAJ | 학술논문

目的：探讨尿肾损伤分子-1（KIM-1）及白细胞介素-18（IL-18）水平在不同程度烧伤患者合并急性肾损伤（AKI）早期诊断中的临床意义。方法将2013年4至9月我院烧伤整形中心95例住院烧伤患者，按烧伤面积、烧伤深度分为轻度烧伤组（37例）、中度烧伤组（30例）及重度烧伤组（28例），另选我院体检中心15名健康体检者作为对照组。分别留取血液及尿液，检测血Hb、WBC、BUN、Cr、ALT、AST、ALB水平；ELISA法检测尿KIM-1及IL-18水平，从而分析尿KIM-1及IL-18与烧伤程度及临床生化指标之间的相关关系。结果（1）轻度烧伤组、中度烧伤组、重度烧伤组及健康对照组的尿KIM-1水平分别为（2.95±0.75）（、4.06±1.38）（、5.06±1.51）、（2.12±0.80）ng/ml，3组烧伤患者的尿 KIM-1水平均明显高于健康对照组（P＜0.05）；三组烧伤患者及健康对照组的尿IL-18水平分别为（6.27±2.84）、（6.93±3.11）、（6.68±2.66）、（6.04±1.41） pg/ml，三组烧伤患者及对照组的尿IL-18水平比较差异无统计学意义。（2）重度烧伤合并AKI患者尿KIM-1[（6.18±1.62）ng/ml]及IL-18水平[（8.87±2.65）pg/ml]明显高于重度烧伤不合并AKI患者[（4.62±1.25）ng/ml，（5.80±2.16）pg/ml]，差异均有统计学意义（P＜0.05），且尿 KIM-1及IL-18升高早于血肌酐升高。（3）尿KIM-1与血清BUN、Scr呈正相关，但与ALB呈负相关（r分别为0.454、0.345、-0.486，P均＜0.05）。尿IL-18与血清Cr低度相关，但与血清BUN、ALB无相关性。结论尿KIM-1、IL-18可以作为预测不同程度烧伤患者合并AKI的早期敏感指标，为烧伤患者早期预防AKI提供一定的临床线索。
목적：탐토뇨신손상분자-1（KIM-1）급백세포개소-18（IL-18）수평재불동정도소상환자합병급성신손상（AKI）조기진단중적림상의의。방법장2013년4지9월아원소상정형중심95례주원소상환자，안소상면적、소상심도분위경도소상조（37례）、중도소상조（30례）급중도소상조（28례），령선아원체검중심15명건강체검자작위대조조。분별류취혈액급뇨액，검측혈Hb、WBC、BUN、Cr、ALT、AST、ALB수평；ELISA법검측뇨KIM-1급IL-18수평，종이분석뇨KIM-1급IL-18여소상정도급림상생화지표지간적상관관계。결과（1）경도소상조、중도소상조、중도소상조급건강대조조적뇨KIM-1수평분별위（2.95±0.75）（、4.06±1.38）（、5.06±1.51）、（2.12±0.80）ng/ml，3조소상환자적뇨 KIM-1수평균명현고우건강대조조（P＜0.05）；삼조소상환자급건강대조조적뇨IL-18수평분별위（6.27±2.84）、（6.93±3.11）、（6.68±2.66）、（6.04±1.41） pg/ml，삼조소상환자급대조조적뇨IL-18수평비교차이무통계학의의。（2）중도소상합병AKI환자뇨KIM-1[（6.18±1.62）ng/ml]급IL-18수평[（8.87±2.65）pg/ml]명현고우중도소상불합병AKI환자[（4.62±1.25）ng/ml，（5.80±2.16）pg/ml]，차이균유통계학의의（P＜0.05），차뇨 KIM-1급IL-18승고조우혈기항승고。（3）뇨KIM-1여혈청BUN、Scr정정상관，단여ALB정부상관（r분별위0.454、0.345、-0.486，P균＜0.05）。뇨IL-18여혈청Cr저도상관，단여혈청BUN、ALB무상관성。결론뇨KIM-1、IL-18가이작위예측불동정도소상환자합병AKI적조기민감지표，위소상환자조기예방AKI제공일정적림상선색。
Objective To investigate the value of urinary kidney injure molecule-1 (KIM-1) and interleukin-18 (IL-18) for early diagnosis of burnt patients in different degree with acute kidney injure(AKI). Methods 95 burnt patients, according to the depth of burn area, were divided into three groups:mild burnt group (n=37), moderate burnt group (n=30) and severe burnt group (n=28), physical examination center of our hospital with 15 healthy volunteers as control group. By using enzyme linked immunosorbent assay (ELISA), we detected levels of urinary KIM-1 and IL-18, analyzed correlation between it and burn severity and clinical indices of renal function. Results (1) The levels of urinary KIM-1 of mild burnt group, moderate burnt group, severe burnt group and healthy control group were (2.95±0.75), (4.06±1.38), (5.06±1.51), (2.12±0.80)ng/ml, urinary KIM-1 levels in the 3 groups of burnt patients were significantly higher than those in the healthy control group (P<0.05);urinary IL-18 levels in the 3 groups of burnt patients and healthy controls were (6.27±2.84), (6.93±3.11), (6.68±2.66), (6.04±1.41)pg/ml, no statistical significance of urinary IL-18 levels in the 3 groups of burnt patients and control group comparison of difference (P>0.05). (2) The levels of urinary KIM-1 [(6.18±1.62) ng/ml] and IL-18 [(8.87±2.65) pg/ml] of severe burnt complicated with acute kidney injury (AKI) group were significantly higher than those of group AKI [combined with severe burnt group were (4.62±1.25) ng/ml and (5.80±2.16) pg/ml], the differences were statistically significant (P<0.05), and urinary KIM-1 and IL-18 increased earlier than the increase of serum creatinine. (3) Urinary KIM-1 and serum BUN, Scr, was positively correlated, however, it negatively correlated with ALB, in which Pearson correlation coefficients were respectively r=0.454, r=0.345, r=-0.486. Urinary IL-18 was positive with Scr, but had no correlation with BUN, Scr, ALB. Conclusion Urinary KIM-1, IL-18 could be regarded as the early sensitive indicator of burnt patients with acute kidney injury and it may become a potential index to prevent burnt patients to develop the AKI.