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-东南大学学报医学版

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

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

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（r_s=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(r_s=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.

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