血清胱抑素C联合尿白介素18对脓毒症并发急性肾损伤的早期预测价值

摘要

目的：探讨血清胱抑素-C ( sCys-C）和尿白介素18( uIL-18）水平检测对严重脓毒症并发急性肾损伤( AKI）的预测价值。方法选择2012年12月—2014年10月在重庆市肿瘤研究所重症医学科住院的严重脓毒症患者，将并发AKI的18例患者归为AKI组，在未发生AKI的患者中选取年龄、性别、原发病种及危重程度等因素与AKI组匹配的20例为非AKI组。分别留取入选患者诊断脓毒症后0、6、10、24、48、72 h的血标本及尿标本，测定各时间点血肌酐(Scr）、 sCys-C及uIL-18水平，采用受试者工作特征曲线(ROC曲线）及曲线下面积(AUC）评价sCys和uIL-8单用或联用时对脓毒症患者并发AKI的早期预测价值。结果 AKI组患者sCys-C和uIL-18分别在诊断脓毒症后24、10 h达到峰值水平，其峰值水平与非AKI组比较，差异均有统计学意义( P＜0.05）。 Pearson相关分析显示， sCys-C与Scr呈正相关(r＝0.966， P＜0.001）， uIL-18与Scr呈正相关(r＝0.873， P＜0.001）。以sCys-C为2.00 mg／L为诊断截点时，其预测脓毒症患者并发AKI的灵敏度和特异度分别为75.2％和77.9％， AUC为0.765〔95％CI (0.646，0.982）， P＜0.05〕；以uIL-18为265 ng／L为诊断截点时，灵敏度为82.7％，特异度为75.0％， AUC为0.785〔95％CI (0.680，1.013）， P＜0.05〕； sCys-C联合uIL-18预测脓毒症患者并发AKI的AUC为0.940〔95％CI (0.829，0.997）， P＜0.01〕。结论脓毒症并发AKI患者sCys-C及uIL-18水平明显升高，这两项指标诊断脓毒症并发AKI的时间点早于Scr；联合应用sCys-C及uIL-18能更早、更准确预测AKI的发生，优于单一指标诊断。%Objective To investigate the value of serum cystatin -C (sCys-C) and urinary interleukin-18 (uIL-18) in the diagnosis and prediction of acute kidney injury in patients with severe sepsis.Methods We enrolled patients with severe sepsis who were hospitalized in the Intensive Care Unit of Chongqing Tumor Research Institute from December 2012 to October 2014, and assigned 18 patients complicated with AKI into AKI group; among the rest patients without AKI, 20 patients with matching age, gender, disease type distribution and severity degree with AKI group were assigned into non-AKI group.At 0 h, 6 h, 10 h, 24 h, 48 h and 72 h after the diagnosis of sepsis, blood samples and urine samples of the patients were taken, and the levels of Scr, sCys-C and uIL-18 at each time point were determined.ROC curves and AUC were employed to investigate the value of the single and combined use of indicators in the early prediction of AKI in sepsis patients.Results The levels of sCys-C and uIL-18 of AKI group were highest at 24 h and 10 h after the diagnosis of sepsis, and the levels were significantly different from those of non-AKI group (P<0.05).Pearson correlation analysis showed that sCys-C was positively correlated with Scr (r =0.966, P<0.001) and uIL-18 was positively correlated with Scr (r=0.873, P<0.001).When sCys-C level was 2.00 mg/L, which was taken as the diagnostic cut-off point, the sensitivity and specificity of sCys-C in the prediction of AKI in sepsis patients were 75.2%and 77.9%, and the AUC was 0.765 〔95%CI (0.646, 0.982), P<0.05〕; when uIL-18 level was 265 ng/L, which was taken as the diagnostic cut -off point, the sensitivity and specificity of uIL-18 were 82.7% and 75.0%, and the AUC was 0.785 〔95%CI (0.680, 1.013), P<0.05〕; the AUC of the value of combined use of sCys-C and uIL-18 in the prediction of AKI in sepsis patients was 0.940 〔95%CI (0.829, 0.997), P<0.01〕.Conclusion Sepsis patients complicated with AKI have distinctly higher levels of sCys-C and uIL-18, and the two indicators can detect the complication of AKI in sepsis patients earlier than Scr.The combined use of sCys-C and uIL-18 can predict AKI earlier and more accurately, which is superior than the use of a single indicator.