尿肾损伤分子-1及血清半胱氨酸蛋白酶抑制剂C对急诊危重症患者急性肾损伤的预测价值

doi:10.3969/j.issn.1002-1949.2018.02.006

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摘要目的探讨应用尿肾损伤分子-1（kidney injury molecule-1， KIM-1）和血清半胱氨酸蛋白酶抑制剂C (CystainC, Cys-C)预测急诊危重症患者入院7 d 内发生急性肾损伤(acute kidney injury, AKI)的价值。方法入选2015-10~2016-10在北京朝阳医院急诊抢救室连续就诊的危重症患者232例，并且患者就诊时监测血肌酐（serum creatinine, SCr）及尿量均在正常范围，同时测定患者的血清Cys-C、尿KIM-1水平，计算急性生理与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ, APACHEⅡ)。自入选之日起，连续监测7 d SCr及尿量变化。依据全球改善肾脏病预后组织(kidney disease improving global outcomes, KDIGO)临床实践指南中的AKI诊断标准将患者分为AKI组（n=99）和非AKI组（n=133）。比较AKI组和非AKI组的尿KIM-1、血清Cys-C水平，同时比较AKI组的尿KIM-1和血清Cys-C在不同KDIGO分期中的水平。应用ROC曲线分析尿KIM-1、血清Cys-C对7 d内发生AKI的预测价值。结果 AKI组患者APACHEⅡ评分明显高于非AKI组［（23±4 ）分 vs.（18±4）分，P＜0.05］。AKI组尿KIM-1、血清Cys-C明显高于非AKI组，分别是［（26.6±9.7）ng/mL vs. (15.9±5.8)ng/mL, P＜0.001］，［(969.3±333.3)ng/mL vs. (632.2±270.4)ng/mL，P＜0.001］。AKI组中，尿KIM-1在KDIGO 1期、2期、3期中分别为(19.3±9.3) ng/mL、(25.3±9.1)ng/mL、(31.0±7.7)ng/mL，各组间尿KIM-1水平差异有统计学意义（P＜0.05）。血清Cys-C在KDIGO 1期、2期、3期中分别为（857.7±341.8）ng/mL、（956.7±382.6）ng/mL、（1031.7±295.5）ng/mL，1期和3期血清Cys-C水平差异有统计学意义（P＜0.05），其他组间差异无统计学意义。尿KIM-1与血清Cys-C是危重症患者7 d内发生AKI的独立预测因素。尿KIM-1预测AKI发生的ROC曲线下面积（0.823）虽然高于血清Cys-C（0.781），但是差异无统计学意义（P＞0.05）。结论监测尿KIM-1和血清Cys-C能有效地预测急诊危重症患者7 d内AKI的发生；与血清Cys-C比较，尿KIM-1水平更能反映AKI的严重程度。

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	王军宇
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	梅雪

收稿日期: 2017-10-30

通讯作者: 梅雪（1971-），男，博士，主任医师，急诊科副主任，E-mail：meixue96@163.com。

作者简介: 王军宇（1972-），男，博士，副主任医师，E-mail：wangjunyu1007@163.com。

引用本文:

王军宇，张达，梅雪. 尿肾损伤分子-1及血清半胱氨酸蛋白酶抑制剂C对急诊危重症患者急性肾损伤的预测价值[J]. 中国急救医学, 2018, 38(2): 118-122.
Wang Jun-yu, Zhang Da, Mei Xue. Assessment of urinary KIM-1 and serum Cystain C in acute kidney injury of critical patients in emergency department. Chinese Journal of Critical Care Medicine, 2018, 38(2): 118-122.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.02.006 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I2/118

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