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摘要: 目的:探讨尿肾损伤分子-1(KIM-1)、可溶性髓样细胞触发受体1(sTREM-1)对脓毒症相关急性肾损伤(SA-AKI)的早期诊断价值。方法:选取2017-08—2019-05期间本院收治的脓毒症患者121例,依据其是否发生SA-AKI,分为AKI组(39例)和非AKI组(82例)。单因素和多因素Logistic回归分析临床资料确定SA-AKI发生的高危因素。采用酶联免疫吸附法测定患者0、12、24 h尿KIM-1和sTREM-1水平。应用受试者工作特征(ROC)曲线分析不同时间点尿KIM-1和sTREM-1水平对SA-AKI的早期诊断价值。结果:SA-AKI的发病率为33.23%(39/121)。与非AKI组相比,AKI组患者血SCr、尿KIM-1、尿sTREM-1和APACHEⅡ评分明显升高,差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示,SCr、尿KIM-1和尿sTREM-1是SA-AKI患者的独立危险因素。在12 h和24 h,AKI组尿KIM-1和sTREM-1水平均明显高于非AKI组,差异有统计学意义(P<0.05)。与24 h尿KIM-1联合sTREM-1对AKI预测效能相比,12 h尿KIM-1联合sTREM-1具有更高的预测效能(Z=4.632,P<0.05),其ROC曲线下面积为0.948(95%CI:0.907~0.989),其诊断灵敏度为93.58%,特异度为87.69%。结论:SA-AKI患者在12 h时尿KIM-1和sTREM-1表达水平明显升高,尿KIM-1和sTREM-1可以作为早期诊断SA-AKI的有效生物标志物,联合检测具有更高的预测效能。
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关键词:
- 脓毒症 /
- 急性肾损伤 /
- 尿肾损伤分子-1 /
- 可溶性髓样细胞触发受体-1 /
- 早期诊断
Abstract: Objective: To investigate the early diagnosis value of urinary kidney injury molecular-1(kim-1) and soluble triggering receptor expressed on myeloid cells-1(sTREM-1) in patients with septic AKI(SA-AKI). Method: One hundred and twenty-one patients with sepsis admitted to our hospital from August 2017 to May 2019 were divided into AKI group(39 cases) and non-AKI group(82 cases) according to the occurrence of AKI. Multivariate logistic regression was performed to identify risk factors of SA-AKI. Urine KIM-1 and sTREM-1 levels were measured at 0, 12 and 24 hours by ELISA. The early diagnostic value of urinary KIM-1 and sTREM-1 levels at different time points for AKI was analyzed by ROC curve. Result: The incidence of SA-AKI was 33.23%(39/121). Compared with non-AKI group, SCr, urine KIM-1, urinary sTREM-1 and APACHE Ⅱ scores were significantly higher in AKI group, the difference was statistically significant(P<0.05). Multivariate logistic regression analysis showed that SCr, urinary KIM-1 and urinary sTREM-1 were independent risk factors for patients with SA-AKI. At 12 h and 24 h, the levels of urinary KIM-1 and sTREM-1 in AKI group were significantly higher than those in non-AKI group(P<0.05). Compared with 24 h urine KIM-1 combined with sTREM-1 for AKI prediction, 12 h urine KIM-1 combined with sTREM-1 had higher predictive power(Z=4.632, P<0.05), and the area under the ROC curve AUC was 0.948(95%CI: 0.907-0.989), its diagnostic sensitivity was 93.58%, and the specificity was 87.69%.Conclusion: In patients with SA-AKI the expression levels of urinary KIM-1 and sTREM-1 were significantly increased at 12 h. Urinary KIM-1 and sTREM-1 could be used as effective biomarkers for early diagnosis of SA-AKI, the combined detection had higher predictive power. -
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