联合标记物检测在重症感染中合并急性肾损伤的诊断价值

目的:探讨尿中性粒细胞明胶酶相关载脂蛋白(neutrophil gelatinase-associated lipocalin,NGAL)、尿肾损伤分子-1(kidneyinjury molecule-1,Kim-1)、尿N-乙酰-β-D-氨基葡萄糖苷酶(N-acecyl-β-D-glucosaminidase,NAG)、尿微量白蛋白(mALB)在重症感染中合并急性肾损伤的敏感性及临床价值。方法:回顾分析60例在新疆自治区人民医院ICU住院的重症感染合并急性肾损伤(AKI)患者的尿NGAL、Kim-1、NAG及mALB的变化情况。健康体检者20例为对照组。尿NGAL、Kim-1、mALB测定采用酶联免疫法(ELISA)检测,尿NAG测定采用对硝基苯酚(PNP)比色法检测,并以ROC曲线分析其敏感性。结果:AKI组患者尿液中的NGAL、Kim-1、NAG、mALB的测定浓度明显高于对照组,差异具有统计学意义(P<0.001),通过ROC曲线、诊断试验结果显示:尿NGAL、Kim-1曲线下面积分别为0.986、0.956,95%可信区间分别是0.968～1.004、0.910～1.001,较尿NAG、mALB更具有敏感性(P<0.001)。结论:尿NGAL、尿Kim-1的浓度检测对重症感染合并急性肾损伤的诊断更具有敏感性,与NAG、mALB联合检测有助于急性肾损伤的早期监测,对预防急性肾损伤的发生、发展具有重要的临床价值。

Diagnostic Value of Combined Detection of Markers in Severe Infection with Acute Kidney Injury

Objective: To explore the sensitivity and clinical value of urine neutrophil gelatinase-associated lipocalin(NGAL),kidney injury molecule-1(Kim-1),urine N-acetyl-beta-D-glucosaminidase(NAG) and urine microalbumin(mALB) in patients of severe infection with acute kidney injury.Methods: Retrospectively analysis the changes of urine NGAL,urine Kim-1,urine NAG and urine mALB in 60 cases of severe infection with acute kidney injury who hospitalized in ICU.20 healthy subjects as control group.The urine NGAL,urine Kim-1 and urine mALB were respectively determined by enzyme linked immunosorbent assay(ELISA),Urine NAG was measured by p-nitropheno(PNP) colorimetric assay,the sensitivity was analyzed by ROC curves.Results: Urine NGAL,Urine Kim-1,urine NAG and urine mALB were significantly higher in AKI group,compared with control group,there were statistically significances between AKI group and control group(P<0.001).Through the ROC curve and diagnostic test,the results showed that,the area under the curve of urine NGAL and urine Kim-1 were 0.986,0.956.the 95% confidence interval of urine NGAL and urine Kim-1 were 0.968-1.004,0.910-1.001.urine NGAL and urine Kim-1were more sensitive than urine NAG and urine mALB(P<0.001).Conclusions: Urine NGAL and urine Kim-1 had more diagnosis sensitivity for patients of severe infection with acute kidney injury.Combined detection of urine NGAL,urine Kim-1,urine NAG and urine mALB were helpful for early diagnosis of acute kidney injury,and had important clinical value on the prevention in pathogenesis and development of acute kidney injury.