中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
19期
1457-1462
,共6页
危重病%肾功能衰竭,急性%诊断%信号素-3A
危重病%腎功能衰竭,急性%診斷%信號素-3A
위중병%신공능쇠갈,급성%진단%신호소-3A
Critical illness%Kidney failure,acute%Diagnosis%Semaphorin3A
目的 探讨信号素3A (Sema3A)对成人重症监护病房急性肾损伤(AKI)的早期诊断价值及其与脓毒症的关系.方法 以中南大学湘雅医院重症医学科(ICU) 2013年7至12月预期入住ICU时间＞24 h入ICU时未发生AKI年龄＞18岁的患者为研究对象.记录患者一般临床资料,并每12 h收集血清、尿标本,用酶联免疫法检测尿Sema3A和中性粒细胞明胶酶相关脂质运载蛋白(NGAL).根据是否发生AKI分为AKI组和非AKI组,根据引起AKI的原因是否为脓毒症分为AKI脓毒症组、AKI非脓毒症组、非AKI脓毒症组、非AKI非脓毒症组.AKI组选取诊断AKI当时及前24h的标本,诊断AKI当时计为T(0)h,前面两个时间点分别计为T(-12)h、T(-24)h.非AKI组取入室后前3个时间点的标本,分别计为T(0)h、T(-12)h、T(-24)h.整理资料进行统计学分析.结果 AKI组尿Sema3A、尿NGAL较非AKI组高(P＜0.05).AKI组尿Sema3A、尿NGAL浓度随时间变化有增高趋势,其中T(-24)h、T(-12)h分别与T(0)h比较差异有统计学意义.T(-24)h尿Sema3A、尿NGAL分别与血肌酐、APACHEⅡ呈正相关性.尿Sema3A以T(-12)h的AUC最大为0.885(95％ CI 0.774 ～0.997,P＜0.05);尿NGAL以T(-24)h的AUC最大为0.878(95％ CI 0.788～0.993,P＜0.05).脓毒症组与非脓毒症组Sema3A差异无统计学意义,而两组间NGAL差异有统计学意义.S-AKI组与非S-AKI组尿Sema3A差异无统计学意义,而两组之间的尿NGAL差异有统计学意义.尿Sema3A死亡组较生存组高(P＜0.05)).结论 尿中Sema3A检测有助于AKI的早期诊断;尿中Sema3A浓度不受脓毒症影响,更有预测价值.
目的 探討信號素3A (Sema3A)對成人重癥鑑護病房急性腎損傷(AKI)的早期診斷價值及其與膿毒癥的關繫.方法 以中南大學湘雅醫院重癥醫學科(ICU) 2013年7至12月預期入住ICU時間＞24 h入ICU時未髮生AKI年齡＞18歲的患者為研究對象.記錄患者一般臨床資料,併每12 h收集血清、尿標本,用酶聯免疫法檢測尿Sema3A和中性粒細胞明膠酶相關脂質運載蛋白(NGAL).根據是否髮生AKI分為AKI組和非AKI組,根據引起AKI的原因是否為膿毒癥分為AKI膿毒癥組、AKI非膿毒癥組、非AKI膿毒癥組、非AKI非膿毒癥組.AKI組選取診斷AKI噹時及前24h的標本,診斷AKI噹時計為T(0)h,前麵兩箇時間點分彆計為T(-12)h、T(-24)h.非AKI組取入室後前3箇時間點的標本,分彆計為T(0)h、T(-12)h、T(-24)h.整理資料進行統計學分析.結果 AKI組尿Sema3A、尿NGAL較非AKI組高(P＜0.05).AKI組尿Sema3A、尿NGAL濃度隨時間變化有增高趨勢,其中T(-24)h、T(-12)h分彆與T(0)h比較差異有統計學意義.T(-24)h尿Sema3A、尿NGAL分彆與血肌酐、APACHEⅡ呈正相關性.尿Sema3A以T(-12)h的AUC最大為0.885(95％ CI 0.774 ～0.997,P＜0.05);尿NGAL以T(-24)h的AUC最大為0.878(95％ CI 0.788～0.993,P＜0.05).膿毒癥組與非膿毒癥組Sema3A差異無統計學意義,而兩組間NGAL差異有統計學意義.S-AKI組與非S-AKI組尿Sema3A差異無統計學意義,而兩組之間的尿NGAL差異有統計學意義.尿Sema3A死亡組較生存組高(P＜0.05)).結論 尿中Sema3A檢測有助于AKI的早期診斷;尿中Sema3A濃度不受膿毒癥影響,更有預測價值.
목적 탐토신호소3A (Sema3A)대성인중증감호병방급성신손상(AKI)적조기진단개치급기여농독증적관계.방법 이중남대학상아의원중증의학과(ICU) 2013년7지12월예기입주ICU시간＞24 h입ICU시미발생AKI년령＞18세적환자위연구대상.기록환자일반림상자료,병매12 h수집혈청、뇨표본,용매련면역법검측뇨Sema3A화중성립세포명효매상관지질운재단백(NGAL).근거시부발생AKI분위AKI조화비AKI조,근거인기AKI적원인시부위농독증분위AKI농독증조、AKI비농독증조、비AKI농독증조、비AKI비농독증조.AKI조선취진단AKI당시급전24h적표본,진단AKI당시계위T(0)h,전면량개시간점분별계위T(-12)h、T(-24)h.비AKI조취입실후전3개시간점적표본,분별계위T(0)h、T(-12)h、T(-24)h.정리자료진행통계학분석.결과 AKI조뇨Sema3A、뇨NGAL교비AKI조고(P＜0.05).AKI조뇨Sema3A、뇨NGAL농도수시간변화유증고추세,기중T(-24)h、T(-12)h분별여T(0)h비교차이유통계학의의.T(-24)h뇨Sema3A、뇨NGAL분별여혈기항、APACHEⅡ정정상관성.뇨Sema3A이T(-12)h적AUC최대위0.885(95％ CI 0.774 ～0.997,P＜0.05);뇨NGAL이T(-24)h적AUC최대위0.878(95％ CI 0.788～0.993,P＜0.05).농독증조여비농독증조Sema3A차이무통계학의의,이량조간NGAL차이유통계학의의.S-AKI조여비S-AKI조뇨Sema3A차이무통계학의의,이량조지간적뇨NGAL차이유통계학의의.뇨Sema3A사망조교생존조고(P＜0.05)).결론 뇨중Sema3A검측유조우AKI적조기진단;뇨중Sema3A농도불수농독증영향,경유예측개치.
Objective To research the early diagnosis value of Semaphorin3A as a biaomarker on acute kidney injury(AKI) in adult intensive care unit(ICU),and explore the relationship between Sema3A and sepsis.Methods The objects of the study are patients who were enrolled from July 2013 to December 2013 in XiangYa Hospital ICU.After admission and study enrollment,clinical data were recorded,and every 12 h serum,urinary samples were collected for Sema3A and neutrophil gelatinase associated lipocalin (NGAL) detected by enzyme linked immunosorbent assay(ELISA).According to the development of AKI,patients were divided into AKI group and non-AKI group.According to whether the AKI induced by sepsis,patients were divided into AKI-sepsis group,AKI-non-sepsis group,non-AKI-sepsis-group,non-AKI-and-non-sepsis group.The samples were selected in AKI group when AKI was diagnosed and 24 h before,the time when AKI diagnosed was counted asT(0)h,the other times were counted as T (-12) h,T (-24) h.In non-AKI group,the samples of the first three time points after admission were selected,and counted as T (0) h,T (-12) h,T (-24) h,respectively.Date was collected for statistical analysis.Results Compared with non-AKI group,AKI urinary Sema3A,urinary NGAL is higher,and the difference was statistically significant.In group AKI urinary Sema3A,urinary NGAL concentration change over time and there is an increasing trend,where the T (-24) h and T(0)h,T (-12) h and T (0) h respective comparison,the difference was statistically significant.Correlation Analysis:T (-24) h urinary Sema3A and urinary NGAL were positively correlated with serum creatinine,APACHE Ⅱ.The AUC of urinary Sema3A with T (-12) h had the largest area of 0.885 (95％ CI 0.774-0.997,P ＜ 0.05);the AUC of urinary NGAL with T (-24) h had the largest area of 0.878 (95％ CI 0.788-0.993,P ＜ 0.05).There was no significant difference between sepsis group and non-sepsis group Sema3A,but there is significant difference between the two groups NGAL.There was no significant difference between S-AKI group and non-S-AKI group urinary Sema3A,but urinary NGAL were significantly different between the two groups.Compared with survival group,urinary Sema3A of death group was higher,and the difference was statistically significant.Conclusion Urinary Sema3A can help early diagnose of adult AKI.Compared to urinary NGAL,the concentration of urinary Sema3A was not affected by sepsis,and will be more useful for prediction.
