中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2013年
6期
423-428
,共6页
脓毒血症%急性肾损伤%可溶性髓系细胞表达的触发受体1%中性粒细胞明胶酶相关脂质运载蛋白
膿毒血癥%急性腎損傷%可溶性髓繫細胞錶達的觸髮受體1%中性粒細胞明膠酶相關脂質運載蛋白
농독혈증%급성신손상%가용성수계세포표체적촉발수체1%중성립세포명효매상관지질운재단백
Sepsis%Acute kidney injury%Triggering receptor expressed on myeloid cells-1%Neutrophil gelatinase-associated lipocalin
目的 探讨尿可溶性髓系细胞表达的触发受体1(sTREM-1)、尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)对脓毒血症并发急性肾损伤(AKI)的早期诊断价值.方法 前瞻性纳入无锡市人民医院ICU收治的脓毒血症患者141例.收集确诊脓毒血症后不同时间点的血、尿标本,检测患者血肌酐、尿sTREM-1和尿NGAL水平.根据是否并发AKI,将患者分为AKI组和非AKI组,观察两组Scr、尿sTREM-1和尿NGAL的动态变化.酶法检测Scr,酶联免疫吸附法测定血sTREM-1、尿sTREM-1和尿NGAL水平.用受试者工作特征曲线(ROC)评价尿sTREM-1和NGAL对AKI的诊断价值.结果 44例脓毒血症患者并发AKI(31.2％).AKI组Scr于脓毒血症确诊后24h上升至基线值的1.91倍[(140.5±13.6)比(82.6±15.3) μmol/L,P＜ 0.05].AKI组患者尿sTREM-1和尿NGAL在脓毒血症确诊后8h开始升高[(100.5±17.4)比(38.9±14.7) ng/L; (144.6±51.9)比(56.2±43.8) μg/L,均P＜0.05],且随后的各时间点均高于基线值(均P＜ 0.05),也高于非AKI组(均P＜0.05).脓毒血症确诊后8h,尿sTREM-1诊断AKI的ROC曲线下面积为0.877,95％CI(0.756 ～ 0.914),以70 ng/L作为诊断AKI的截取值时,其敏感性和特异性分别为89.1％和82.0％；尿NGAL预测AKI的ROC曲线下面积为0.862,95％ CI(0.703～ 0.958),以90 μg/L作为诊断AKI的截取值时,其敏感性和特异性分别为87.4％和85.5％.结论 脓毒血症确诊8h后尿sTREM-1和NGAL水平对AKI具有预测价值,其诊断时间早于Scr.尿sTREM-1和NGAL可作为脓毒血症并发AKI患者的早期诊断的标志物.
目的 探討尿可溶性髓繫細胞錶達的觸髮受體1(sTREM-1)、尿中性粒細胞明膠酶相關脂質運載蛋白(NGAL)對膿毒血癥併髮急性腎損傷(AKI)的早期診斷價值.方法 前瞻性納入無錫市人民醫院ICU收治的膿毒血癥患者141例.收集確診膿毒血癥後不同時間點的血、尿標本,檢測患者血肌酐、尿sTREM-1和尿NGAL水平.根據是否併髮AKI,將患者分為AKI組和非AKI組,觀察兩組Scr、尿sTREM-1和尿NGAL的動態變化.酶法檢測Scr,酶聯免疫吸附法測定血sTREM-1、尿sTREM-1和尿NGAL水平.用受試者工作特徵麯線(ROC)評價尿sTREM-1和NGAL對AKI的診斷價值.結果 44例膿毒血癥患者併髮AKI(31.2％).AKI組Scr于膿毒血癥確診後24h上升至基線值的1.91倍[(140.5±13.6)比(82.6±15.3) μmol/L,P＜ 0.05].AKI組患者尿sTREM-1和尿NGAL在膿毒血癥確診後8h開始升高[(100.5±17.4)比(38.9±14.7) ng/L; (144.6±51.9)比(56.2±43.8) μg/L,均P＜0.05],且隨後的各時間點均高于基線值(均P＜ 0.05),也高于非AKI組(均P＜0.05).膿毒血癥確診後8h,尿sTREM-1診斷AKI的ROC麯線下麵積為0.877,95％CI(0.756 ～ 0.914),以70 ng/L作為診斷AKI的截取值時,其敏感性和特異性分彆為89.1％和82.0％；尿NGAL預測AKI的ROC麯線下麵積為0.862,95％ CI(0.703～ 0.958),以90 μg/L作為診斷AKI的截取值時,其敏感性和特異性分彆為87.4％和85.5％.結論 膿毒血癥確診8h後尿sTREM-1和NGAL水平對AKI具有預測價值,其診斷時間早于Scr.尿sTREM-1和NGAL可作為膿毒血癥併髮AKI患者的早期診斷的標誌物.
목적 탐토뇨가용성수계세포표체적촉발수체1(sTREM-1)、뇨중성립세포명효매상관지질운재단백(NGAL)대농독혈증병발급성신손상(AKI)적조기진단개치.방법 전첨성납입무석시인민의원ICU수치적농독혈증환자141례.수집학진농독혈증후불동시간점적혈、뇨표본,검측환자혈기항、뇨sTREM-1화뇨NGAL수평.근거시부병발AKI,장환자분위AKI조화비AKI조,관찰량조Scr、뇨sTREM-1화뇨NGAL적동태변화.매법검측Scr,매련면역흡부법측정혈sTREM-1、뇨sTREM-1화뇨NGAL수평.용수시자공작특정곡선(ROC)평개뇨sTREM-1화NGAL대AKI적진단개치.결과 44례농독혈증환자병발AKI(31.2％).AKI조Scr우농독혈증학진후24h상승지기선치적1.91배[(140.5±13.6)비(82.6±15.3) μmol/L,P＜ 0.05].AKI조환자뇨sTREM-1화뇨NGAL재농독혈증학진후8h개시승고[(100.5±17.4)비(38.9±14.7) ng/L; (144.6±51.9)비(56.2±43.8) μg/L,균P＜0.05],차수후적각시간점균고우기선치(균P＜ 0.05),야고우비AKI조(균P＜0.05).농독혈증학진후8h,뇨sTREM-1진단AKI적ROC곡선하면적위0.877,95％CI(0.756 ～ 0.914),이70 ng/L작위진단AKI적절취치시,기민감성화특이성분별위89.1％화82.0％；뇨NGAL예측AKI적ROC곡선하면적위0.862,95％ CI(0.703～ 0.958),이90 μg/L작위진단AKI적절취치시,기민감성화특이성분별위87.4％화85.5％.결론 농독혈증학진8h후뇨sTREM-1화NGAL수평대AKI구유예측개치,기진단시간조우Scr.뇨sTREM-1화NGAL가작위농독혈증병발AKI환자적조기진단적표지물.
Objective To determine whether triggering receptor expressed on myeloid cells-1 (sTREM-1) and urinary neutrophil gelatinase-associated lipocalin (NGAL) were early biomarkers of acute kidney injury (AKI) secondary to sepsis.Methods A total of 141 eligible patients were enrolled in this prospective study.Blood and urine samples were collected at different time points as soon as sepsis was diagnosed.The concentrations of serum creatinine (Scr),urine sTREM-1 and NGAL were measured.According to AKI criteria,patients were divided into the AKI group and non-AKI group.Dynamic changes of levels of Scr,urine sTREM-1 and NGAL were observed in two groups.The receiver operating characteristic curves were used to evaluate the early diagnostic value of urine sTREM-1 and NGAL.Results Among 141 septic patients,44 (31.2％) cases had concomitant AKI.Twenty four hours after sepsis diagnosed,the level of Scr rose to 1.91 times of the baseline [(140.5±13.6) vs (82.6± 15.3) μmol/L,P ＜ 0.05],which met the diagnostic criteria of AKI.In the AKI group,urinary concentrations of sTREM-1 and NGAL at 8 h after the diagnosis of sepsis began to rise significantly from baseline [(100.5±17.4) vs (38.9± 14.7) ng/L; (144.6±51.9) vs (56.2±43.8) μg/L,both P ＜ 0.05].And at the following time points,urinary concentrations of sTREM-1 and NGAL were significantly higher than the baseline levels and that of the non-AKI group (all P ＜ 0.05).At 8 h time point,thearea under the curve of urine sTREM-1 was 0.877 (95％CI 0.756-0.914),the sensitivity was 89.1％ and specificity was 82.0％ with a cutoff value of 70 ng/L.At 8 h time point,the area under the curve of urine NGAL was 0.862 (95％ CI 0.703-0.958),the sensitivity was 87.4％ and specificity was 85.5％ with a cutoff value of 90 μg/L.Conclusions Urinary concentrations of sTREM-1 and NGAL at 8 h time point after the diagnosis of sepsis have predictive value for AKI and their diagnostic time is much earlier than that of Scr.Therefore,urinary sTREM-1 and NGAL can be used as early biomarkers of septic AKI.
