中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2014年
9期
545-549
,共5页
任玉倩%吕鑫%张育才%崔云%徐梁%戎群芳
任玉倩%呂鑫%張育纔%崔雲%徐樑%戎群芳
임옥천%려흠%장육재%최운%서량%융군방
中性粒细胞明胶酶相关脂质运载蛋白%急性肾损伤%血肌酐%脓毒症%儿童
中性粒細胞明膠酶相關脂質運載蛋白%急性腎損傷%血肌酐%膿毒癥%兒童
중성립세포명효매상관지질운재단백%급성신손상%혈기항%농독증%인동
Neutrophil gelatinase-associated lipocalin%Acute kidney injury%Serum creatinine%Sepsis%Children
目的 评估尿中性粒细胞明胶酶相关脂质运载蛋白(urine neutrophil gelatinase-associated lipocalin,uNGAL)对PICU患儿急性肾损伤的早期诊断价值.方法 对象是上海交通大学附属儿童医院2013年4月至6月期间PICU收治的80例危重症患儿.入PICU后连续观察72 h,根据急性肾损伤(acute kidney injury,AKI) pRIFLE标准将患儿分为AKI组15例和非AKI组65例.根据脓毒症的诊断标准将患儿分为脓毒症组31例和非脓毒症组49例,于入科6h内、24 h、48 h及72 h留取患儿尿液和血液测定uNGAL和血肌酐(serum creatinine,Scr).比较AKI组与非AKI组、脓毒症未合并AKI组与非脓毒症非AKI组、脓毒症合并AKI组与脓毒症未合并AKI组间uNGAL水平的差异,以及AKI组Scr和uNGAL之间的相关度,绘制ROC曲线评价48 h uNGAL和Scr对危重症患儿AKI诊断的敏感性和特异性.结果 80例患儿中有13例进展为AKI.(1)AKI组6h内、24 h、48 h、72 h uNGAL[M(QR),ng/ml]水平分别为863.00(696.00)、700.50(580.00)、365.50(285.00)、289.50(319.30),明显高于非AKI组[20.00(106.00)、20.00 (85.30)、20.00(101.00)、20.00(36.00)] (P ＜0.01).(2)新发展AKI组患儿uNGAL值各时间点均明显高于非AKI组,两组48 h Scr水平间差异有统计学意义.(3)脓毒症未合并AKI组uNGAL水平病初时升高,48 h后逐渐降至正常,与非脓毒症非AKI组比较差异无统计学意义.(4)脓毒症合并AKI组uNGAL水平持续明显升高,与脓毒症未合并AKI组比较差异有统计学意义(P＜0.01).(5)48 h uNGAL和Scr的ROC曲线下面积分别为0.902(95％ CI:0.801 ～1.004)和0.874(95％ CI:0.768 ～0.981).结论 uNGAL在儿童危重症合并AKI时较Scr提前24 ～ 48 h升高,反映疾病的严重程度,可以作为PICU患儿AKI的早期诊断标志物.
目的 評估尿中性粒細胞明膠酶相關脂質運載蛋白(urine neutrophil gelatinase-associated lipocalin,uNGAL)對PICU患兒急性腎損傷的早期診斷價值.方法 對象是上海交通大學附屬兒童醫院2013年4月至6月期間PICU收治的80例危重癥患兒.入PICU後連續觀察72 h,根據急性腎損傷(acute kidney injury,AKI) pRIFLE標準將患兒分為AKI組15例和非AKI組65例.根據膿毒癥的診斷標準將患兒分為膿毒癥組31例和非膿毒癥組49例,于入科6h內、24 h、48 h及72 h留取患兒尿液和血液測定uNGAL和血肌酐(serum creatinine,Scr).比較AKI組與非AKI組、膿毒癥未閤併AKI組與非膿毒癥非AKI組、膿毒癥閤併AKI組與膿毒癥未閤併AKI組間uNGAL水平的差異,以及AKI組Scr和uNGAL之間的相關度,繪製ROC麯線評價48 h uNGAL和Scr對危重癥患兒AKI診斷的敏感性和特異性.結果 80例患兒中有13例進展為AKI.(1)AKI組6h內、24 h、48 h、72 h uNGAL[M(QR),ng/ml]水平分彆為863.00(696.00)、700.50(580.00)、365.50(285.00)、289.50(319.30),明顯高于非AKI組[20.00(106.00)、20.00 (85.30)、20.00(101.00)、20.00(36.00)] (P ＜0.01).(2)新髮展AKI組患兒uNGAL值各時間點均明顯高于非AKI組,兩組48 h Scr水平間差異有統計學意義.(3)膿毒癥未閤併AKI組uNGAL水平病初時升高,48 h後逐漸降至正常,與非膿毒癥非AKI組比較差異無統計學意義.(4)膿毒癥閤併AKI組uNGAL水平持續明顯升高,與膿毒癥未閤併AKI組比較差異有統計學意義(P＜0.01).(5)48 h uNGAL和Scr的ROC麯線下麵積分彆為0.902(95％ CI:0.801 ～1.004)和0.874(95％ CI:0.768 ～0.981).結論 uNGAL在兒童危重癥閤併AKI時較Scr提前24 ～ 48 h升高,反映疾病的嚴重程度,可以作為PICU患兒AKI的早期診斷標誌物.
목적 평고뇨중성립세포명효매상관지질운재단백(urine neutrophil gelatinase-associated lipocalin,uNGAL)대PICU환인급성신손상적조기진단개치.방법 대상시상해교통대학부속인동의원2013년4월지6월기간PICU수치적80례위중증환인.입PICU후련속관찰72 h,근거급성신손상(acute kidney injury,AKI) pRIFLE표준장환인분위AKI조15례화비AKI조65례.근거농독증적진단표준장환인분위농독증조31례화비농독증조49례,우입과6h내、24 h、48 h급72 h류취환인뇨액화혈액측정uNGAL화혈기항(serum creatinine,Scr).비교AKI조여비AKI조、농독증미합병AKI조여비농독증비AKI조、농독증합병AKI조여농독증미합병AKI조간uNGAL수평적차이,이급AKI조Scr화uNGAL지간적상관도,회제ROC곡선평개48 h uNGAL화Scr대위중증환인AKI진단적민감성화특이성.결과 80례환인중유13례진전위AKI.(1)AKI조6h내、24 h、48 h、72 h uNGAL[M(QR),ng/ml]수평분별위863.00(696.00)、700.50(580.00)、365.50(285.00)、289.50(319.30),명현고우비AKI조[20.00(106.00)、20.00 (85.30)、20.00(101.00)、20.00(36.00)] (P ＜0.01).(2)신발전AKI조환인uNGAL치각시간점균명현고우비AKI조,량조48 h Scr수평간차이유통계학의의.(3)농독증미합병AKI조uNGAL수평병초시승고,48 h후축점강지정상,여비농독증비AKI조비교차이무통계학의의.(4)농독증합병AKI조uNGAL수평지속명현승고,여농독증미합병AKI조비교차이유통계학의의(P＜0.01).(5)48 h uNGAL화Scr적ROC곡선하면적분별위0.902(95％ CI:0.801 ～1.004)화0.874(95％ CI:0.768 ～0.981).결론 uNGAL재인동위중증합병AKI시교Scr제전24 ～ 48 h승고,반영질병적엄중정도,가이작위PICU환인AKI적조기진단표지물.
Objective To evaluate the value of urine neutrophil gelatinase-associated lipocalin (uNGAL) to early diagnose acute kidney injury(AKI) of critically ill children in PICU.Methods Eighty critically ill children at PICU of Children's Hospital Affiliated to Shanghai Jiaotong University were enrolled in this study from April to June 2013.They were continuously observed for 72 hours.According to pediatric RIFLE criteria for diagnosis of AKI,patients were divided into AKI group (15 cases) or non-AKI group (65 cases).Additionally,according to sepsis diagnostic criteria,patients were divided into sepsis group (31 cases) or non-sepsis group (49 cases).The levels of serum creatinine and uNGAL were measured within 6th hour,24th hour,48th hour,72th hour after admitted to PICU.The differences of uNGAL levels between AKI and non-AKI groups,sepsis without AKI and non-sepsis non-AKI groups,sepsis merged AKI and sepsis without AKI groups were analysed.The sensitivity and specificity of uNGAL and serum creatinine for diagnosis of AKI at 48th hour were evaluated by ROC curve.Results Thirteen cases of eighty children developed to AKI after admitted to PICU.(1)The uNGAL levels [M(QR),ng/ml] in AKI group within 6th hour,at 24th hour,48th hour,72th hour were 863.00 (696.00),700.50 (580.00),365.50 (285.00),289.50 (319.30),respectively,which were significantly higher than those in non-AKI group [20.00 (106.00),20.00 (85.30),20.00(101.00),20.00(36.00)] (P ＜0.01).(2)The uNGAL levels in new developed group were much higher than those in non-AKI group at each time point.The comparision of serum creatinine at 48th hour was statistic difference.(3)The uNGAL levels rised at early stage in sepsis without AKI group and down to normal gradually after 48th hour.(4)The uNGAL levels continued increasing in sepsis merged AKI group,and had significant differences comparing with sepsis without AKI group(P ＜ 0.01).(5) The areas under ROC curve of uNGAL and serum creatinine at 48th hour were 0.902(95％ CI:0.801 ～ 1.004) and 0.801 (95％ CI:0.768 ～ 0.981),respectively.Conclusion The level of uNGAL has earlier increase for 24 to 48 hours than that of serum creatinine in critically ill children,and it can also reflect the severity of AKI.Therefore it can be used as an early diagnostic biomarker for AKI in PICU.
