尿肾损伤分子1和肝型脂肪酸结合蛋白水平对脓毒症急性肾损伤的预测价值
Predictive value of urine concentration of KIM-1 and L-FABP for acute renal injury in sepsis patients

高洁等.尿肾损伤分子1和肝型脂肪酸结合蛋白水平对脓毒症急性肾损伤的预测价值[J].内科急危重症杂志,2020,26(3):212-215

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DOI：10.11768/nkjwzzzz20200309

中文关键词: 脓毒症 急性肾损伤 尿肾损伤分子1 肝型脂肪酸结合蛋白

英文关键词:

基金项目:上海市嘉定区卫生局课题(No:2016 KY 06)

作者	单位	E-mail
高洁等	上海市南翔医院	zhang chao 103202@126.com

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中文摘要:

目的: 探讨尿中肾损伤分子1(KIM-1)和肝型脂肪酸结合蛋白（L-FABP）水平对脓毒症急性肾损伤（AKI）的预测价值。方法: 收集117例脓毒症患者的临床资料，按照是否发生AKI分为脓毒症非AKI组（76例）和脓毒症AKI组（41例）。采用ELISA法检测尿KIM-1及L-FABP水平，运用受试者工作特征(ROC)曲线及曲线下面积(AUC)，评估尿KIM-1、L-FABP水平及单独或联合检测对脓毒症AKI的预测价值。结果:与脓毒症非AKI组比较，脓毒症AKI患者尿KIM-1水平在-24、0、24、48h时间点显著升高 (均P＜0.05)。脓毒症患者发生AKI前24h，将其尿KIM-1、L-FABP水平单独或联合检测的ROC曲线进行分析，AUC分别为0.792、0.781和0.818(均P＜0.05)。当取KIM-1截断值为21.00ng/L时，敏感性为0.8780，特异性为0.6447。当取L-FABP截断值为14.00ng/L时，敏感性为0.7317，特异性为0.7368。建立KIM-1联合L-FABP检测的预测模型，取截断值为0.2239时，敏感性为0.8780，特异性为0.6711。结论:脓毒症发生AKI前24h检测患者尿KIM-1及L-FABP水平，有助于预测脓毒症AKI的发生，联合检测价值较单独检测更大。

英文摘要:

Objective: To evaluate the prognostic value of urine concentration of kidney injury molecule-1 (KIM-1) and liver-type fatty acid binding protein (L-FABP) in sepsis-induced acute renal injury (AKI). Methods: Clinical data of 117 sepsis patients were collected, and according to the occurrence of AKI, they were divided into non-AKI group (76 cases) and AKI group (41 cases). Urine concentration of KIM-1 and L-FABP were analyzed by enzyme linked immune sorbent assay (ELISA). The changes of urine KIM-1 and L-FABP concentration and their predictive value for sepsis-induced AKI were evaluated by receiver operating characteristic (ROC) curve and area under curve (AUC). Results: The urine KIM-1 concentration in sepsis patients with AKI was significantly higher at -24h, 0, 24h and 48h than that in non-AKI group (all P<0.05). The ROC curves of KIM-1, L-FABP at -24h before the onset of AKI in sepsis patients and their combined detection were analyzed. The results showed that AUC was 0.792, 0.781 and 0.818, respectively (P<0.05). When KIM-1 cut-off >21.00ng/L was taken, the sensitivity and specificity were 0.8780 and 0.6447 respectively. When L-FABP cut-off >14.00ng/L, the sensitivity and specificity were 0.7317 and 0.7368 respectively. The prediction model of KIM-1 combined with L-FABP was established. When cut-off >0.2239, the sensitivity and specificity were 0.8780 and 0.6711 respectively. Conclusion: Urine KIM-1 and L-FABP can be detected 24h before the onset of AKI in sepsis, which is helpful for the prediction of AKI in sepsis. Combined detection is more valuable than single detection.