NGAL、KIM-1和PCT在脓毒症AKI中的标志物作用

探讨NGAL与KIM-1联合检测和PCT在重症监护病房重症患者中急性肾损伤(AKI)发生中的作用。选取2018年1月至2019年6月我院101例重症患者,其中脓毒症AKI组61例,非AKI组40例,通过分析NGAL、KIM-1和PCT在2组患者中表达水平变化情况,结合与ACR指标对比分析,评价NGAL、KIM-1和PCT在脓毒症急性肾损伤早期诊断中的价值。结果显示,所有脓毒症AKI患者均检测出明显更高的尿NGAL生物标志物水平(67.32μg/g Cr)。尿KIM-1和尿NGAL水平升高与患者ACR升高均呈正相关(p<0.001),而在脓毒症AKI患者中PCT和ACR之间观察到显著的负相关(r_s=-0.102 5, p=0.307)。通过Kruskal-Wallis检验发现,NGAL和KIM-1值显示出与脓毒症严重程度具有显著统计学意义,且直接成比例的关系(p≤0.01)。进一步检查NGAL、KIM-1和PCT标志物与病情发展的相关性表明,PCT值似乎与临床结果没有很强的相关性。尿KIM-1联合NGAL在早期检测脓毒症AKI中具有较大的预测价值;PCT是有希望的脓毒症标志物之一,但不足以提供可靠诊断依据,在肾功能下降的患者中通过PCT进行脓毒症的临床诊断需要更加谨慎。

Role of NGAL,KIM-1 and PCT Markers in Acute Renal Injury of Sepsis

The aim of this study was to investigate the role of combined detection of NGAL and KIM-1 and PCT in the development of acute kidney injury(AKI) in critically ill patients in intensive care unit. From January 2018 to June 2019, 101 critically ill patients were enrolled in our hospital, including 61 patients with septic AKI and 40 patients with non-AKI. The expression levels of NGAL, KIM-1 and PCT were analyzed in two groups. Changes,combined with ACR indicators, to evaluate the value of NGAL, KIM-1 and PCT in the early diagnosis of acute kidney injury in sepsis. All patients with septic AKI detected significantly higher levels of urinary NGAL biomarkers(67.32 μg/g Cr). Elevated levels of urinary KIM-1 and urinary NGAL were positive in patients with elevated ACR.Correlation(p<0.001), and a significant negative correlation was observed between PCT and ACR in patients with sepsis AKI(rs=-0.1025, p=0.307). Found by Kruskal-Wallis test, NGAL and KIM The-1 value showed a statistically significant and directly proportional relationship with the severity of sepsis(p≤0.01). Further examination of NGAL,KIM-1, correlation of PCT markers with disease progression The PCT value does not seem to have a strong correlation with clinical outcomes. Urine KIM-1 combined with NGAL has great predictive value in the early detection of sepsis AKI;PCT is one of the promising markers of sepsis, but it is not enough to provide a reliable basis for diagnosis in patients with decreased renal function. The clinical diagnosis of sepsis by PCT requires more caution.