尿液TIMP-2·IGFBP-7预测脓毒症患儿急性肾损伤的可行性研究

摘要

目的 探讨尿液中金属蛋白酶组织抑制因子-2(TIMP-2)及胰岛素样生长因子结合蛋白-7(IGFBP-7)水平变化预测脓毒症患儿急性肾损伤(AKI)发生的可行性和准确性.方法 纳入2014年3月至2017年3月成都市妇女儿童中心医院儿童重症医学科(PICU)收治的脓毒症患儿174例,以及健康对照儿童30例(对照组).于入PICU前7d每天8:00时抽取空腹静脉血检测血清肌酐(SCr)水平;每天8:00、20:00时留取新鲜尿液检测TIMP-2及IGFBP-7水平.依据2012年改善全球肾脏病预后组织(KDIGO)标准诊断AKI,进而将脓毒症惠儿分为AKI组和非AKI组.采用受试者工作特征曲线(ROC)及曲线下面积(AUC)分析患儿AKI诊断前12、24、36、48 h尿液中[TIMP-2]·[IGFBP-7]对AKI的预测价值.结果 174例脓毒症患儿入PICU前7d内共52例(29.89％)诊断AKI.非AKI组与对照组尿中[TIMP-2]·[IGFBP-7]水平比较,差异无统计学意义(P＞0.05).AKI诊断前12、24、36 h尿中[TIMP-2]·[IGFBP-7]水平较入PICU时明显升高(P＜0.01);尿液中[TIMP-2]·[TGFBP-7]水平升高预测其后12、24、36 h时AKI发生的AUC分别为0.967(95％CI:0.946～0.989)、0.898(95％CI:0.844～0.951)、0.748(95％CI:0.669～0.827),均差异有统计学意义(P＜0.01).结论 脓毒症患儿尿液中TIMP-2及IGFBP-7水平升高可较为准确地预测AKI的发生.%Objective To explore the feasibility and accuracy of urinary tissue inhibitor of metalloproteinase-2(TIMP-2) and insulin-like growth factor binding protein-7(IGFBP-7) for predicting acute kidney injury(AKI) occurrence in pediatric patients with sepsis.Methods A total of 174 pediatric patients with sepsis in PICU of Chengdu Municipal Women and Children Central Hospital and 30 healthy control children(control group) from March 2014 to March 2017 were included.Fasting venous blood was collected at 8:00 every morning during 7 d before admitting to PICU for detecting serum SCr level;fresh urine sample was taken at 8:00 am and 20:00 pm.for detecting TIMP-2 and IGFBP-7 levels.The AKI was diagnosed according to KDIGO criteria in 2012.Thus the septic children patients were divided into the AKI group and non-AKI group.The receiver operating characteristic(ROC) curve and the area under the curve(AUC) were adopted to analyze the predictive value of TIMP-2 and IGFBP-7 at 12,24,36,48 h before diagnosis for AKI.Results Within 7 d in 174 children cases admitting to PICU,52 cases(29.89％) were diagnosed as AKI.The TIMP-2 and IGFBP-7 levels had no statistical difference between the non-AKI group and control group(P＞0.05).Urinary TIMP-2 and IGFBP-7 levels at 12,24,36 h before diagnosing AKI were significantly increased compared with those at admitting to PICU(P＜0.01);AUC of urinary TIMP-2 and IGFBP-7 levels for predicting AKI occurrence within following 12,24,36 h were 0.967 (95 ％CI:0.946-0.989),0.898(95％CI:0.844-0.951) and 0.748(95％CI:0.669-0.827) respectively,the difference was statistically significant(P＜0.01).Conclusion The urinary TIMP-2 and IGFBP-7 increase can more accurately predict AKI occurrence in pediatric patients with sepsis.