肾损伤分子-1对肝硬化继发肾功能损害早期预测的价值

摘要

Objective To investigate the clinical value of serum kidney injury molecule‐1(KIM‐1) lever in the early prediction of renal dysfunction secondary to liver cirrhosis .Methods 104 patients with liver cirrhosis ,including 32 cases of complicating hepatorenal syndrome(HRS) ,were selected and divided into the grade A (22 cases) ,grade B (32 cases) and grade C (50 cases) based on the Child‐Pugh cirrhosis classification .20 individuals of healthy physical examination were selected as the control group .Serum KIM‐1 level was measured by the enzyme‐linked immunosor‐bent assay (ELISA) .Area under the receiver operating characteristic curve (AUROC) was constructed to analyze the accuracy rate of serum KIM‐1 level for the diagnosis of HRS .At the same time ,the correlation analysis between KIM‐1 with eGRF ,Cys‐C and Scr was performed .Results Along with the elevation of levels of liver cirrhosis classi‐fication ,eGRF was gradually decreased and serum KIM‐1 level was increased gradually (P<0 .05) .The serum KIM‐1 level of the patients with cirrhosis complicating HRS was significantly higher than that of the patients with simple cirrhosis (P<0 .01) .The AUROC of serum KIM‐1 for diagnosis of HRS secondary to liver cirrhosis was 0 .850(P<0 .01) .The correlation analysis showed that the positive correlation between KIM‐1 with Cys‐C and Scr respectively (r=0 .178 ,0 .129 ,P<0 .01) and the negative correlation between KIM‐1 with eGFR (r= -0 .396 ,P<0 .01) were found .Conclusion Serum KIM‐1 conduces to early monitoring the renal dysfunction secondary to liver cirrhosis and has the important clinical value for preventing the occurrence and development of HRS .%目的：探讨肾损伤分子‐1（KIM‐1）在肝硬化继发肾功能损害早期预测的价值。方法选取肝硬化患者104例，其中合并肝肾综合征（HRS）32例。所有患者按肝功能Child‐Pugh积分分级，A级22例，B级32例，C级50例。另选取健康体检者20例作为对照组。测定外周血KIM‐1水平，进行KIM‐1诊断 HRS的ROC曲线分析，并将KIM‐1与估算肾小球滤过率（eGRF）、胱抑素‐C（Cys‐C）、血肌酐（Scr）进行相关性分析。结果肝硬化患者随着Child‐Pugh分级的上升，eGRF逐渐下降，血KIM‐1的水平逐渐升高（P＜0．05）。肝硬化并 HRS患者血KIM‐1水平明显高于单纯肝硬化患者（P＜0．01）。KIM‐1诊断HRS的ROC曲线下面积为0．850（P＜0．01）。KIM‐1与Cys‐C、Scr呈正相关（r分别为0．178、0．129，P＜0．01），与 eGFR呈负相关（r＝－0．396，P＜0．01）。结论血K IM‐1有助于肝硬化继发肾功能损害的早期监测，对预防 H RS的发生、发展具有重要的临床价值。