肾损伤标志性蛋白在烧伤延迟复苏患者急性肾损伤早期诊断中的价值

李晓亮; 叶向阳; 李琰光; 肖宏涛; 赵孝开; 张建; 冯可; 田社民; 娄季鹤; 夏成德

doi:10.3760/cma.j.cn501120-20200915-00411

肾损伤标志性蛋白在烧伤延迟复苏患者急性肾损伤早期诊断中的价值

doi: 10.3760/cma.j.cn501120-20200915-00411

郑州市第一人民医院烧伤科 450004

基金项目:

河南省医学科技攻关项目（201602321、2018020728）

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出版历程
- 收稿日期: 2020-09-15
- 网络出版日期: 2021-10-28
- 刊出日期: 2021-02-20

Value of renal injury marker protein in early diagnosis of acute kidney injury in burn patients with delayed resuscitation

Department of Burns, Zhengzhou First People′s Hospital, Zhengzhou 450004, China

摘要

摘要:
目的探讨肾损伤标志性蛋白在烧伤延迟复苏患者急性肾损伤(AKI)早期诊断中的价值。方法采用回顾性病例对照研究方法。2018年5月—2020年5月，郑州市第一人民医院收治43例符合入选标准的烧伤延迟复苏患者，其中男27例、女16例，年龄18～75(35±3)岁，按伤后7 d内是否发生AKI分为AKI组23例及非AKI组20例。比较2组患者性别、年龄、深Ⅱ度烧伤面积、Ⅲ度烧伤面积、急性生理学和慢性健康状况评价Ⅱ，统计伤后12、24、48 h补液量和血清肌酐及伤后12、24、48、72、120、168 h血清白蛋白/纤维蛋白原比值(AFR)，尿热休克蛋白70(HSP70)、金属蛋白酶组织抑制因子2(TIMP-2)×胰岛素样生长因子结合蛋白7(IGFBP-7)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)。对数据行Mann-Whitney
U
检验、重复测量方差分析、独立样本
t
检验、
χ
²检验及Bonferroni校正，行多因素logistic回归分析筛选预测AKI发生的自变量，绘制预测烧伤延迟复苏患者AKI发生的受试者操作特征曲线，计算诊断AKI的曲线下面积(AUC)、最佳阈值及最佳阈值下的敏感度、特异度。结果 2组患者性别、年龄、深Ⅱ度烧伤面积、Ⅲ度烧伤面积、急性生理学和慢性健康状况评价Ⅱ相近(
χ
²＝1.98，
t
＝1.98、1.99、1.99、1.99，
P
>0.05)。AKI组患者伤后24、48 h补液量明显少于非AKI组(
t
＝15.37、6.51，
P
<0.01)。AKI组患者伤后12、24、48 h血清肌酐明显高于非AKI组(
Z
＝2.16、5.62、6.72，
P
<0.01)。AKI组患者伤后12、24、48、72、120、168 h血清AFR明显低于非AKI组(
t
＝16.14、35.35、19.60、20.47、30.20、20.17，
P
<0.01)。AKI组患者伤后12、24、48、72、120、168 h尿HSP70为(6.89±0.87)、(6.42±0.73)、(5.81±0.72)、(5.17±0.56)、(4.63±0.51)、(3.89±0.51)μg/L，明显高于非AKI组的(3.89±0.75)、(3.57±0.63)、(2.66±0.41)、(1.83±0.35)、(1.48±0.19)、(1.28±0.19)μg/L，
t
＝12.00、13.61、17.39、22.98、26.34、21.59，
P
<0.01。AKI组患者伤后12、24、48、72、120、168 h尿TIMP-2×IGFBP-7、NGAL明显高于非AKI组(
t
＝26.94、101.11、35.50、66.89、17.34、14.30，14.00、13.78、12.32、14.80、21.36、22.62，
P
<0.01)。将伤后12 h尿HSP70和血清AFR，伤后24 h尿TIMP-2×IGFBP-7、NGAL纳入多因素logistic回归分析(比值比＝2.42、3.47、7.52、5.61，95%置信区间＝1.99～2.95、1.86～3.92、2.87～9.68、2.14～14.69，
P
<0.01)。对43例烧伤延迟复苏患者，伤后12 h血清AFR预测AKI发生的受试者操作特征曲线AUC为0.739(95%置信区间＝0.576～0.903)，最佳阈值为9.90，敏感度为82%，特异度为90%；伤后12 h尿HSP70 AUC为0.990(95%置信区间＝0.920～1.000)，最佳阈值为1.40 μg/L，敏感度为98%，特异度为96%；伤后24 h尿TIMP-2×IGFBP-7 AUC为0.715(95%置信区间＝0.512～0.890)，最佳阈值为114.20 μg²/L²，敏感度为91%，特异度为95%；伤后24 h尿NGAL AUC为0.972(95%置信区间＝0.860～1.000)，最佳阈值为78 μg/L，敏感度为95%，特异度为96%。结论尿HSP70、NGAL对烧伤延迟复苏导致的AKI具有较高诊断价值。
- 烧伤 /
- 早期诊断 /
- 急性肾损伤 /
- 延迟复苏 /
- 肾损伤标志物
Abstract:
Objective To explore the value of renal injury marker protein in early diagnosis of acute kidney injury (AKI) in burn patients with delayed resuscitation. Methods The retrospective case-control research was conducted. Forty-three burn patients with delayed resuscitation (27 males and 16 females, with age of 18-75 (35±3) years)who were admitted to Zhengzhou First People′s Hospital from May 2018 to May 2020 met the inclusion criteria. The patients were divided into AKI group with 23 patients and non-AKI group with 20 patients according to whether AKI occurred within 7 days after burns. The gender, age, deep partial-thickness burn area, full-thickness burn area, and acute physiology and chronic health evaluation Ⅱ of patients were compared between the two groups.The fluid supplement volume and serum creatinine at 12, 24, and 48 h after burn, serum albumin/fibrinogen ratio (AFR), urinary heat shock protein 70 (HSP70), tissue inhibitor of metalloproteinase-2 (TIMP-2)×insulin-like growth factor binding protein 7 (IGFBP-7), and neutrophil gelatinase associated lipocalin (NGAL)at 12, 24, 48, 72, 120, and 168 h after burn were detected.Data were statistically analyzed with Mann-Whitney
U
test, analysis of variance for repeated measurement, independent-samples
t
test, chi-square test and Bonferroni correction. The independent variable to predict the occurrence of AKI was screened by multi-factor logistic regression analysis. The receiver′s operating characteristic curve was drawn for predicting the occurrence of AKI in burn delayed resuscitation patients, and the area under the curve (AUC), the best threshold, and the sensitivity and specificity under the best threshold were calculated. Results The gender, age, deep partial-thickness burn area, full-thickness burn area, acute physiology and chronic health evaluation Ⅱ of patients in two groups were similar (
χ
²=1.98,
t
=1.98, 1.99, 1.99, 1.99,
P
>0.05). The fluid supplement volume of patients in AKI group at 24 and 48 h after burn was significantly less than that in non-AKI group (
t
=15.37, 6.51,
P
<0.01). The serum creatinine of patients in AKI group at 12, 24, and 48 h after burn was significantly higher than that in non-AKI group (
Z
=2.16, 5.62, 6.72,
P
<0.01). The serum AFR of patients in AKI group at 12, 24, 48, 72, 120, and 168 h after burn was significantly lower than that in non-AKI group (
t
=16.14, 35.35, 19.60, 20.47, 30.20, 20.17,
P
<0.01). The levels of urinary HSP70 of patients in AKI group at 12, 24, 48, 72, 120, and 168 h after burn were (6.89±0.87), (6.42±0.73), (5.81±0.72), (5.17±0.56), (4.63±0.51), (3.89±0.51) μg/L, which were significantly higher than (3.89±0.75), (3.57±0.63), (2.66±0.41), (1.83±0.35), (1.48±0.19), (1.28±0.19) μg/L in non-AKI group (
t
=12.00, 13.61, 17.39, 22.98, 26.34, 21.59,
P
<0.01). Urinary TIMP-2×IGFBP-7 and NGAL of patients in AKI group at 12, 24, 48, 72, 120, 168 h after burn were significantly higher than those in non-AKI group (
t
=26.94, 101.11, 35.50, 66.89, 17.34, 14.30, 14.00, 13.78, 12.32, 14.80, 21.36, 22.62,
P
<0.01). Urinary HSP70 and serum AFR at 12 h after burn, urinary TIMP-2×IGFBP-7 and NGAL at 24 h after burn were included into multi-factor logistic regression analysis (odds ratio=2.42, 3.47, 7.52, 5.61, 95% confidence interval=1.99-2.95, 1.86-3.92, 2.87-9.68, 2.14-14.69,
P
<0.01). For 43 patients with burn delayed resuscitation, the AUC of receiver′s operating characteristic curve of serum AFR at 12 h after burn for predicting AKI was 0.739 (95% confidence interval=0.576-0.903), the optimal threshold was 9.90, the sensitivity was 82%, and the specificity was 90%. The AUC of urinary HSP70 at 12 h after burn was 0.990 (95% confidence interval=0.920-1.000), the optimal threshold was 1.40 μg/L, the sensitivity was 98%, and the specificity was 96%. The AUC of urinary TIMP-2×IGFBP-7 at 24 h after burn was 0.715 (95% confidence interval=0.512-0.890), the optimal threshold was 114.20 μg²/L², the sensitivity was 91%, and the specificity was 95%. The AUC of urinary NGAL at 24 h after burn was 0.972 (95% confidence interval=0.860-1.000), the optimal threshold was 78 μg/L, the sensitivity was 95%, and the specificity was 96%. Conclusions Urinary HSP70 and NGAL have higher value in early diagnosis of AKI in burn patients with delayed resuscitation.
- Burns /
- Early diagnosis /
- Acute kidney injury /
- Delayed resuscitation /
- Renal injury marker