KIM-1、CC16在急性肾/肺损伤临床诊断中的意义
KIM-1、CC16재급성신/폐손상림상진단중적의의
The significance of KIM-1 、CC16 in acute kidney injury and acute lung injure
  • 万方数据
    国际泌尿系统杂志 국제비뇨계통잡지
    INTERNATIONAL JOURNAL OF UROLOGY AND NEPHROLOGY
    2014年 1期 1-8 ,共8页

    申晓丽%周巧玲%王祺

    신효려%주교령%왕기

    肾%肺%蛋白质类 腎%肺%蛋白質類
    신%폐%단백질류
    Kidney%Lung%Proteins
    目的 观察肾损伤分子-1(kidney injury molecule 1,KIM-1)与Clara细胞分泌蛋白(Clara cell secretionprotein,CCSP/CC16)在急性肾损伤(Acute Kidney Injury,AKI)合并急性肺损伤(Acute Lung Injury,ALI)患者体内的变化,探讨其在急性肾/肺损伤临床诊断中的意义.方法 入选本院确诊为AKI的患者纳入AKI组(25例),确诊为ALI的患者纳入ALI组(15例),确诊为AKI合并ALI的患者纳入AKI+ALI组(25例),与之年龄、性别、民族相匹配的非吸烟健康志愿者作为正常对照组(23例),采用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)检测尿液KIM-1、尿液CC16和血浆KIM-1、血浆CC16的水平,用比色法检测尿N-乙酰-β-D-氨基葡萄糖苷酶(N-acetyl-beta-D-glucosaminidase,NAG),整理四组所有研究资料利用统计学方法进行综合分析.结果 与正常非吸烟对照组相比,AKI组的尿NAG酶、尿KIM-1、血浆KIM-1和血浆CC16水平均显著升高,差异有统计学意义(P＜0.05);ALI组的尿CC16和血浆CC16水平均显著升高,差异有统计学意义(P ＜0.05);AKI+ALI组的尿NAG酶、尿KIM-1、血浆KIM-1、尿CC16和血浆CC16水平均显著升高,差异有统计学意义(P＜0.05).直线相关分析显示:AKI患者的尿KIM-1水平与尿NAG呈显著正相关关系(r=0.493,P＜0.01),血浆KIM-1水平与尿NAG无直线相关关系(r =0.276,P＞0.05).ALI患者的尿CC16、血浆CC16与氧合指数均呈显著负相关关系(r=0.460,P＜0.01;r=0.468,P＜0.01).AKI合并ALI患者的尿KIM-1、血浆KIM-1与尿CC16、血浆CC16均呈显著正相关关系(P＜0.05).ROC曲线分析提示:在AKI诊断中,尿KIM-1曲线下面积为0.781(95％ CI:0.688 ～0.875,P＜0.01);血浆KIM-1曲线下面积为0.988(95％ CI:0.000～1.000,P＜0.01);尿NAG酶曲线下面积为0.798 (95％CI:0.708～0.888,P＜0.01).在ALI诊断中,尿CC16曲线下面积为1.000(95％ CI:1.000 ～1.000,P＜0.01);血浆CC16曲线面积为0.849(95％ CI:0.764～0.935,P＜0.01).结论 AKI时尿NAG、尿KIM-1、血浆KIM-1均明显升高,进一步证实这些指标可作为诊断AKI早期生物学标志物.ALI时尿CC16、血浆CC16水平显著升高,同时具有高敏感性,是诊断ALI的良好实验室指标.急性肾/肺损伤患者体内尿、血浆KIM-1与CC16水平明显升高,二者具有良好的相关性,对诊断急性肾/肺损伤并判断预后具有重要的价值与临床意义.
    목적 관찰신손상분자-1(kidney injury molecule 1,KIM-1)여Clara세포분비단백(Clara cell secretionprotein,CCSP/CC16)재급성신손상(Acute Kidney Injury,AKI)합병급성폐손상(Acute Lung Injury,ALI)환자체내적변화,탐토기재급성신/폐손상림상진단중적의의.방법 입선본원학진위AKI적환자납입AKI조(25례),학진위ALI적환자납입ALI조(15례),학진위AKI합병ALI적환자납입AKI+ALI조(25례),여지년령、성별、민족상필배적비흡연건강지원자작위정상대조조(23례),채용매련면역흡부법(enzyme-linked immunosorbent assay,ELISA)검측뇨액KIM-1、뇨액CC16화혈장KIM-1、혈장CC16적수평,용비색법검측뇨N-을선-β-D-안기포도당감매(N-acetyl-beta-D-glucosaminidase,NAG),정리사조소유연구자료이용통계학방법진행종합분석.결과 여정상비흡연대조조상비,AKI조적뇨NAG매、뇨KIM-1、혈장KIM-1화혈장CC16수평균현저승고,차이유통계학의의(P＜0.05);ALI조적뇨CC16화혈장CC16수평균현저승고,차이유통계학의의(P ＜0.05);AKI+ALI조적뇨NAG매、뇨KIM-1、혈장KIM-1、뇨CC16화혈장CC16수평균현저승고,차이유통계학의의(P＜0.05).직선상관분석현시:AKI환자적뇨KIM-1수평여뇨NAG정현저정상관관계(r=0.493,P＜0.01),혈장KIM-1수평여뇨NAG무직선상관관계(r =0.276,P＞0.05).ALI환자적뇨CC16、혈장CC16여양합지수균정현저부상관관계(r=0.460,P＜0.01;r=0.468,P＜0.01).AKI합병ALI환자적뇨KIM-1、혈장KIM-1여뇨CC16、혈장CC16균정현저정상관관계(P＜0.05).ROC곡선분석제시:재AKI진단중,뇨KIM-1곡선하면적위0.781(95％ CI:0.688 ～0.875,P＜0.01);혈장KIM-1곡선하면적위0.988(95％ CI:0.000～1.000,P＜0.01);뇨NAG매곡선하면적위0.798 (95％CI:0.708～0.888,P＜0.01).재ALI진단중,뇨CC16곡선하면적위1.000(95％ CI:1.000 ～1.000,P＜0.01);혈장CC16곡선면적위0.849(95％ CI:0.764～0.935,P＜0.01).결론 AKI시뇨NAG、뇨KIM-1、혈장KIM-1균명현승고,진일보증실저사지표가작위진단AKI조기생물학표지물.ALI시뇨CC16、혈장CC16수평현저승고,동시구유고민감성,시진단ALI적량호실험실지표.급성신/폐손상환자체내뇨、혈장KIM-1여CC16수평명현승고,이자구유량호적상관성,대진단급성신/폐손상병판단예후구유중요적개치여림상의의.
    Objectives To investigate the change of kidney injury molecule 1 (KIM-1) and Clara cell secretion protein(CCSWCC16) in the patients with acute kidney injury(AKI) and acute lung injury(ALI),and study the significance of acute kidney/lung injury.Methods A study was conducted in 25 pure AKI patients,15 pure ALI patients,25 AKI and ALI patients,and 23 non-smoking controls (age,race,and gender-matched).ELISA method to detect urinary KIM-1 、plasma KIM-1 、urinary CC16 and plasma CC16; colorimetric method to detect urinary N-acetyl-beta-D-glucosaminidase(NAG).Results Campa~d with non-smoking control group,the urinary NAG 、urinary KIM-1 、plasma KIM-1 and plasma CC16 values were significantly increased in AKI group(P ＜0.05) ; the urinary CC16 and plasma CC16 values were significantly increased in ALI group (P ＜0.05) ;the urinary NAG、urinary KIM-1 、plasma KIM-1 、urinary CC16 and plasma CC16 values were significantly increased in AKI and ALI group(P ＜ 0.05).Correlation analysis showed:In AKI patients,urinary KIM-1 was positive correlated with urinary NAG (r =0.493,P ＜0.01),while the plasma KIM-1 was no correlated with urinary NAG.In ALI patients,urinary CC16 was negative correlated with oxygenation index,the same as plasma CC16(P ＜0.01).In AKI and ALI group,urinary KIM-1 、plasma KIM-1were positive associated with urinary CC16 and plasma CC16 respectively (P ＜ 0.05).3.Receiver operator characteristic curve (ROC) analysis showed:In AKI,the area under the curve (AUC) of urinary KIM-1 was 0.781 (95 ％ CI 0.688 ～ 0.875,P ＜ 0.01) ; plasma KIM-1 was 0.988 (95％ CI 0.000 ～ 1.000,P ＜ 0.01) ; urinary NAG was 0.798 (95％ CI 0.708 ～ 0.888,P ＜ 0.01).In ALI,the AUC of urinary CC 16 was 1.000 (95 ％ CI 1.000 ～ 1.000,P ＜ 0.01) ; plasma CC 16 was 0.849 (95 ％ CI 0.764 ～ 0.935,P ＜ 0.01).Conclusions Urinary NAG,urinary KIM-1 and plasma KIM-1 were obviously increased in AKI,showed that these indicators can be used to early diagnose AKI.Urinary CC16 and plasma CC16 were significantly elevated in ALI,and with high sensitivity,suggested that CC16 can serve as a good biomarker for ALI.Urinary and plasma KIM-1 and CC16 were significantly increased in acute kidney/lung injury and with good correlation,showed that KIM-1,CC16 have clinical significance for diagnosis and prognosis of acute kidney/lung injury.
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