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血清和尿NGAL、KIM-1、CysC对晚发型败血症新生儿急性肾损伤的早期预警价值
作者:朱道谋1  钟丽花2  陈彩华2 
单位:1. 海南省妇女儿童医学中心 急诊科, 海南 海口 570000;
2. 海南省妇女儿童医学中心 新生儿科, 海南 海口 570000
关键词:新生儿 晚发型败血症 急性肾损伤 中性粒细胞明胶酶相关脂质运载蛋白 
分类号:R722.131
出版年·卷·期(页码):2021·40·第二期(176-182)
摘要:

目的:探讨晚发型败血症(LOS)新生儿血清和尿液中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子-1(KIM-1)及胱抑素C(CysC)水平对于急性肾损伤(AKI)的早期预警价值。方法:回顾性分析2017年10月至2019年12月我院收治的120例LOS新生儿的临床资料,用改良AKIN分期系统进行评估,分为AKI组(n=23)和非AKI组(n=97)。在入院后2 d内采集4次(0、12、24、48 h)血液和尿液样本,采用ELISA法检测血清和尿NGAL、KIM-1及CysC的水平,绘制受试者工作特征(ROC)曲线,评价入院时血清和尿NGAL、KIM-1及CysC对LOS患儿早期AKI的预测价值。应用多因素Logistic回归分析LOS患儿继发AKI的危险因素。结果:入院2 d内AKI组患儿血清和尿NGAL、KIM-1、CysC水平均高于非AKI组(P<0.05)。根据AKI分级标准,Ⅲ级组(n=4)患儿血清NGAL水平和尿NGAL、KIM-1水平高于Ⅰ级组(n=12)(P<0.05)。经多因素Logistic回归分析,尿NGAL(OR=6.507,95%CI 1.899~17.431)、KIM-1(OR=2.304,95%CI 1.385~5.496)及CysC(OR=1.420,95%CI 1.097~2.641)水平升高是LOS患儿继发AKI的独立危险因素(P<0.05)。经ROC曲线分析,尿NGAL的曲线下面积(AUC)大于血清NGAL(P<0.05)。而血清与尿中KIM-1、CysC比较,预测AKI的AUC差异无统计学意义(P>0.05)。经Spearman相关分析,相较于血清NGAL,尿NGAL与实际结果的相关性更高(rs=0.588,P<0.05)。经H-L拟合优度检验,血清和尿NGAL、KIM-1、CysC对AKI的预测效果与实际结果拟合度良好(均P>0.05)。结论:LOS继发性早期AKI患儿表现为早期血清和尿NGAL、KIM-1、CysC水平普遍升高,相较于血清NGAL,检测尿NGAL对于AKI的预警效能更高。

Objective: To investigate the early predictive value of serum or urinary neutrophil gelatinase-associated lipocalin(NGAL), kidney injury molecule-1(KIM-1) and cystatin(CysC) for acute kidney injury(AKI) in neonates with late-onset sepsis(LOS). Methods: A total of 120 LOS neonates admitted to our hospital from October 2017 to December 2019 were retrospectively analyzed and divided into AKI group(n=23) and non-AKI group(n=97) according to modified AKIN staging system. Serum and urine samples were collected at 0, 12, 24 and 48 h after admission. The expressions of NGAL, KIM-1 and CysC in serum and urine were detected by ELISA method. The receiver operating characteristic(ROC) curve was drawn to evaluate the predictive value of NGAL, KIM-1 and CysC in serum and urine at admission for early AKI in neonates with LOS. Multivariate Logistic regression was used to analyze the risk factors of secondary AKI in neonates with LOS. Results: Within 2 days after admission, the levels of NGAL, KIM-1 and CysC in serum and urine of AKI group were higher than those of non-AKI group(P<0.05). According to AKI staging standard, the levels of serum NGAL and urinary NGAL, KIM-1 in Grade Ⅲ group(n=4) were higher than that in Grade Ⅰ group(n=12) (P<0.05). Multivariate Logistic regression showed that urinary NGAL(OR=6.507, 95% CI 1.899-17.431), KIM-1(OR=2.304, 95% CI 1.385-5.496) and CysC(OR=1.420, 95% CI 1.097-2.641) were independent risk factors for secondary AKI in neonates with LOS(P<0.05). The area under ROC curve(AUC) of urinary NGAL was higher than that of serum NGAL(P<0.05). There was no significant difference in AUC value of KIM-1 or CysC in serum and urine samples(P>0.05). By Spearman analysis, the correlation between urinary NGAL and actual results was higher than that of serum NGAL(rs=0.588, P<0.05). In addition, by H-L goodness of fit test, serum and urinary NGAL, KIM-1, CysC had a good fit with the actual results(all P>0.05). Conclusion: Serum and urinary NGAL, KIM-1 and CysC have certain early predictive value for AKI in neonates with LOS, and urinary NGAL has the highest predictive effect.

参考文献:

[1] ALCOCK G,LILEY H G,COOKE L,et al.Prevention of neonatal late-onset sepsis:a randomised controlled trial[J].BMC Pediatr,2017,17(1):98.
[2] VLACHOPANOS G,SCHIZAS D,HASEMAKI N,et al.Pathophysiology of contrast-induced acute kidney injury(CIAKI)[J].Curr Pharm Des,2019,25(44):4642-4647.
[3] 张伟,于文娟,陈云庆,等.免疫组织化学在具有嗜酸细胞形态肾肿瘤鉴别诊断中的作用[J].中华病理学杂志,2016,45(10):692-697.
[4] XIAO X,TANG R,ZHOU X,et al.Aldosterone induces NRK-52E cell apoptosis in acute kidney injury via rno-miR-203 hypermethylation and Kim-1 upregulation[J].Exp Ther Med,2016,12(2):915-924.
[5] 徐茂青,钟祥薇,李萍,等.NGAL、CysC、β2-MG和SCr联合检测在妊娠期高血压早期肾损伤诊断中的应用价值[J].当代医学,2020,26(25):71-73.
[6] SHANE A L,SÁNCHEZ P J,STOLL B J.Neonatal sepsis[J].Lancet,2017,390(10104):1770-1780.
[7] MEMAR M Y,ALIZADEH N,VARSHOCHI M,et al.Immunologic biomarkers for diagnostic of early-onset neonatal sepsis[J].J Matern Fetal Neonatal Med,2019,32(1):143-153.
[8] GOWDA H,NORTON R,WHITE A,et al.Late-onset Neonatal Sepsis-A 10-year Review From North Queensland,Australia[J].Pediatr Infect Dis J,2017,36(9):883-888.
[9] CHARLTON J R,BOOHAKER L,ASKENAZI D,et al.Late onset neonatal acute kidney injury:results from the AWAKEN Study[J].Pediatr Res,2019,85(3):339-348.
[10] SWEETMAN D U.Neonatal acute kidney injury-Severity and recovery prediction and the role of serum and urinary biomarkers[J].Early Hum Dev,2017,105:57-61.
[11] LEVEY A S,JAMES M T.Acute kidney injury[J].Ann Intern Med,2017,167(9):ITC66-ITC80.
[12] UENO K,SEKI S,SHIOKAWA N,et al.Validation of acute kidney injury according to the modified KDIGO criteria in infants after cardiac surgery for congenital heart disease[J].Nephrology(Carlton),2019,24(3):294-300.
[13] MOLEDINA D G,PARIKH C R.Phenotyping of acute kidney injury:beyond serum creatinine[J].Semin Nephrol,2018,38(1):3-11.
[14] EL-FARGHALI O G,EL-RAGGAL N M,MAHMOUD N H,et al.Serum neutrophil gelatinase-associated lipocalin as a predictor of acute kidney injury in critically-ill neonates[J].Pak J Biol Sci,2012,15(5):231-237.
[15] SHANG W,WANG Z.The update of NGAL in acute kidney injury[J].Curr Protein Pept Sci,2017,18(12):1211-1217.
[16] YANG L,BROOKS C R,XIAO S,et al.KIM-1-mediated phagocytosis reduces acute injury to the kidney[J].J Clin Invest,2015,125(4):1620-1636.
[17] ZHANG L,SUN J,ZHANG M,et al.The significance of combined detection of CysC,urinary mAlb and β2-MG in diagnosis of the early renal injury in pregnancy-induced hypertension syndrome[J].Saudi J Biol Sci,2019,26(8):1982-1985.
[18] 葛斌,刘艳,徐革,等.建立NGAL诊断阈值有利于临床判断和发现急性肾功能损伤[J].基因组学与应用生物学,2019,26(3):1434-1441.

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