中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2014年
7期
494-499
,共6页
刘华杰%沈云琳%孙蕾%匡新宇%张儒舫%张泓%周君梅%李小兵%黄文彦
劉華傑%瀋雲琳%孫蕾%劻新宇%張儒舫%張泓%週君梅%李小兵%黃文彥
류화걸%침운림%손뢰%광신우%장유방%장홍%주군매%리소병%황문언
敏感性与特异性%基因%儿童%生物学标志物
敏感性與特異性%基因%兒童%生物學標誌物
민감성여특이성%기인%인동%생물학표지물
Sensitivity and specificity%Genes%Child%Biomarker
目的 探讨血清补体应答基因-32(RGC-32)在儿童急性肾损伤(AKI)中的早期预测价值.方法 选择2013年3至6月在上海交通大学附属儿童医院住院并接受心肺分流术(CPB)的67例先天性心脏病患儿为CPB组,参照pRIFLE标准分为AKI组(23例)及非AKI组(44例).选取同期同年龄段健康体检儿童30名作为对照组.动态观察CPB组患儿术前、术后30 min、2h、4h、24h、48 h、72 h血清RGC-32、肌酐(Scr)及胱抑素C(CysC)水平.应用受试者工作特征曲线(ROC)及曲线下面积(AUC)评价并比较三者早期预测AKI发生的敏感性和特异性.结果 23例AKI患儿的pRIFLE分期:危险期15例,损伤期4例,衰竭期3例,丧失期1例.AKI组血清RGC-32于术后30 min即显著升高,明显高于非AKI组差异有统计学意义[(2.88±0.68) μg/Lvs.(1.39±0.31)μg/L,P＜0.05].术后2h、4h、24 h、48 h,AKI组血清RGC-32浓度仍持续高于非AKI组,差异均具有统计学意义(t=2.180、2.818、2.226、3.017,P均＜0.05);CPB术后30 min、2h、4h、24 h、48 h、72 h血清RGC-32预测AKI发生的AUC分别为0.770、0.707、0.768、0.728、0.723、0.770,均＞0.7;CPB术后30 min、2h、4h血清RGC-32敏感性为0.914、0.824、0.824,特异性为0.619、0.667、0.810,CPB术后30 min、2h、4 h CysC敏感性为0.625、0.813、0.813,特异性为0.571、0.619、0.571;术后30 min、2h、4 h Scr敏感性为0.625、0.625、0.813,特异性为0.571、0.571、0.524.结论 与CysC、Scr相比,血清RGC-32可更早预测AKI发生,能否作为一种新型早期诊断AKI的生物标志物,尚需进一步验证.
目的 探討血清補體應答基因-32(RGC-32)在兒童急性腎損傷(AKI)中的早期預測價值.方法 選擇2013年3至6月在上海交通大學附屬兒童醫院住院併接受心肺分流術(CPB)的67例先天性心髒病患兒為CPB組,參照pRIFLE標準分為AKI組(23例)及非AKI組(44例).選取同期同年齡段健康體檢兒童30名作為對照組.動態觀察CPB組患兒術前、術後30 min、2h、4h、24h、48 h、72 h血清RGC-32、肌酐(Scr)及胱抑素C(CysC)水平.應用受試者工作特徵麯線(ROC)及麯線下麵積(AUC)評價併比較三者早期預測AKI髮生的敏感性和特異性.結果 23例AKI患兒的pRIFLE分期:危險期15例,損傷期4例,衰竭期3例,喪失期1例.AKI組血清RGC-32于術後30 min即顯著升高,明顯高于非AKI組差異有統計學意義[(2.88±0.68) μg/Lvs.(1.39±0.31)μg/L,P＜0.05].術後2h、4h、24 h、48 h,AKI組血清RGC-32濃度仍持續高于非AKI組,差異均具有統計學意義(t=2.180、2.818、2.226、3.017,P均＜0.05);CPB術後30 min、2h、4h、24 h、48 h、72 h血清RGC-32預測AKI髮生的AUC分彆為0.770、0.707、0.768、0.728、0.723、0.770,均＞0.7;CPB術後30 min、2h、4h血清RGC-32敏感性為0.914、0.824、0.824,特異性為0.619、0.667、0.810,CPB術後30 min、2h、4 h CysC敏感性為0.625、0.813、0.813,特異性為0.571、0.619、0.571;術後30 min、2h、4 h Scr敏感性為0.625、0.625、0.813,特異性為0.571、0.571、0.524.結論 與CysC、Scr相比,血清RGC-32可更早預測AKI髮生,能否作為一種新型早期診斷AKI的生物標誌物,尚需進一步驗證.
목적 탐토혈청보체응답기인-32(RGC-32)재인동급성신손상(AKI)중적조기예측개치.방법 선택2013년3지6월재상해교통대학부속인동의원주원병접수심폐분류술(CPB)적67례선천성심장병환인위CPB조,삼조pRIFLE표준분위AKI조(23례)급비AKI조(44례).선취동기동년령단건강체검인동30명작위대조조.동태관찰CPB조환인술전、술후30 min、2h、4h、24h、48 h、72 h혈청RGC-32、기항(Scr)급광억소C(CysC)수평.응용수시자공작특정곡선(ROC)급곡선하면적(AUC)평개병비교삼자조기예측AKI발생적민감성화특이성.결과 23례AKI환인적pRIFLE분기:위험기15례,손상기4례,쇠갈기3례,상실기1례.AKI조혈청RGC-32우술후30 min즉현저승고,명현고우비AKI조차이유통계학의의[(2.88±0.68) μg/Lvs.(1.39±0.31)μg/L,P＜0.05].술후2h、4h、24 h、48 h,AKI조혈청RGC-32농도잉지속고우비AKI조,차이균구유통계학의의(t=2.180、2.818、2.226、3.017,P균＜0.05);CPB술후30 min、2h、4h、24 h、48 h、72 h혈청RGC-32예측AKI발생적AUC분별위0.770、0.707、0.768、0.728、0.723、0.770,균＞0.7;CPB술후30 min、2h、4h혈청RGC-32민감성위0.914、0.824、0.824,특이성위0.619、0.667、0.810,CPB술후30 min、2h、4 h CysC민감성위0.625、0.813、0.813,특이성위0.571、0.619、0.571;술후30 min、2h、4 h Scr민감성위0.625、0.625、0.813,특이성위0.571、0.571、0.524.결론 여CysC、Scr상비,혈청RGC-32가경조예측AKI발생,능부작위일충신형조기진단AKI적생물표지물,상수진일보험증.
Objective To investigate the new biomarkers of acute kidney injury,as well as to confirm the values of response gene to complement 32 (RGC-32) for early diagnosis of acute kidney injury by comparing the values of serum creatinine (Scr) and cystatin C (CysC) in children who had undergone cardiopulmonary bypass (CPB).Method Sixty-seven patients who had accepted CPB were recruited from the cardiac surgery intensive care unit,Children's Hospital Affiliated to Shanghai Jiao Tong University from March to June 2013 and assigned to acute kidney injury group (group AKI) or non-acute kidney injury group (group non-AKI),on the basis of the definition by the pediatric RIFLE (pRIFLE) criteria.Also 30 healthy control children were recruited.Serum samples were taken regularly from each patient after CPB at 30 min,2 h,4 h,24 h,48 h and 72 h for RGC-32.Serum samples were tested by enzyme linked immunosorbent assay (ELISA) which was employed to determine the levels of serum RGC-32.Scr and CysC were analyzed by HITACHI 7180 automatic biochemical analyzer.All the data were analyzed by receiver operator characteristic curve (ROC) and area under curve (AUC).Result The incidence of AKI was 34％ (23/ 67),including 15 cases with risk stage AKI,4 cases with injury stage AKI,3 cases with failure stage AKI,1 cases with loss stage AKI.Three out of four subjects with Failure stage AKI and the one case with Loss stage all accepted renal replacement therapy.CPB group had a higher level of serum RGC-32 than that of pre-operation after CPB 30 minute [(2.88 ±0.68) μg/L vs.(1.39 ±0.31) μg/L,P ＜0.05].At the same time,comparing with the non-AKI group,the levels of serum RGC-32 were higher than that of controls 30 min,2 h,4 h,24 h and 48 h after CPB (t =2.560,2.180,2.818,2.226,3.017 ; P ＜ 0.05).The values for the AUC were determined for RGC-32 as 0.770,0.707,0.768,0.728,0.723 and 0.770 after CPB 30 min,2 h,4 h,24 h,48 h and 72 h.The values for sensitivity of serum RGC-32 30 min,2 h and 4 h after CPB was 0.914,0.824,0.824 and the values for specificity of serum RGC-32 was 0.619,0.667,0.810,respectively.But the values for sensitivity of CysC was 0.625,0.813,0.813,and specificity 0.571,0.619,0.571,respectively.The values for sensitivity of Scr was 0.625,0.625,0.813 and specificity was 0.571,0.571,0.524,respectively.Conclusion The sensitivity of serum RGC-32 for detecting AKI was much higher than that of Scr and serum CysC in children who had accepted CPB,and that RGC-32 may be a new biomarker for early detection of AKI.However,the conclusion needs to be further elucidated.
