胰岛素样生长因子结合蛋白7在肝硬化患者急性肾损伤时的诊断价值

摘要

Objective:To investigate the value of insulin-like growth factor-binding protein 7 ( IGFBP7) in estimation of acute kidney injury in patients with liver cirrhosis.Methods:One hundred and sixty-eight patients with hepatocirrhosis treated in our hospital between March of 2015 and 2017 were in-cluded and divided into acute kidney injury group(n=53) and non-acute kidney injury group(n=115).Enzyme linked immunosorbent assay (ELISA)kit was used to measure IGFBP7 levels in the urine.The receiver operating characteristic (ROC) curve was used to analyze the predicting value of urinary IG-FBP7 for acute kidney injury in patients with liver cirrhosis.Results:Patients in the acute kidney injury group had higher levels of TBIL,Scr,BUN,CysC,β2-MG,MELD-Na and IGFBP7,yet lower blood Na+ and eGFR levels than those in the non-acute kidney injury group (P< 0.05).Pearson correlation a-nalysis showed that the urinary IGFBP7 levels in patients with acute kidney injury were positively correlated with Scr,BUN,CysC,β2-MG and MELD-Na scores (r=0.486,0.405,0.363,0.572 and 0.432,respectively,P<0.05),and negatively correlated with eGFR (r=0.513,P<0.05).The results of ROC curve analysis showed that the area under the curve of urinary IGFBP7 in diagnosis of acute kidney injury in patients with liver cirrhosis was larger than Scr and BUN.When the cut-off value of IGFBP7 was 20.75μg/L,the sensitivity and specificity were 96.20% and 86.96%,respectively.Conclusion:The uri-nary level of IGFBP7 can be elevated in acute kidney injury in patients with liver cirrhosis,and used as an indicator for early diagnosis of the renal injury.%目的:探讨胰岛素样生长因子结合蛋白7(IGFBP7)在肝硬化患者急性肾损伤时的诊断价值.方法:选取2015年3月~2017年3月在我院住院治疗的肝硬化患者168例,分为急性肾损伤组(n=53)和非急性肾损伤组(n=115),利用酶联免疫吸附试验(ELISA法)试剂盒检测尿液中IGFBP7水平,利用受试者工作特征曲线(ROC曲线)分析尿IGFBP7水平在预测肝硬化发生急性肾损伤中的价值.结果:急性肾损伤组患者TBIL、Scr、BUN、CysC、β2-MG、MELD-Na评分、IGFBP7水平均高于非急性肾损伤组,而血Na+和eGFR均低于非急性肾损伤组,差异均有统计学意义(P<0.05);Pearson相关分析显示,急性肾损伤组患者尿IGFBP7水平与Scr、BUN、CysC、β2-MG和MELD-Na评分均呈正相关(r=0.486、0.405、0.363、0.572和0.432,P<0.05),而与eGFR呈负相关(r=0.513,P<0.05);ROC曲线分析结果显示,尿IGFBP7在诊断肝硬化发生急性肾损伤时曲线下面积大于Scr和BUN,当尿IGFBP7取截断值20.75μg/L时,灵敏度为96.20%,特异度为86.96%.结论:肝硬化患者发生急性肾损伤时尿IGFBP7水平升高,可作为早期诊断的指标.