摘要
目的 探讨可溶性血栓调节蛋白(sTM)联合肾损伤分子1(KIM-1)对原发性肾病综合征(PNS)所致急性肾损伤(AKI)的早期诊断价值.方法 选取2019年1月—2022年10月中山市人民医院收治的177例PNS患者,依据是否发生AKI分为AKI组(102例)和非AKI组(75例).对比两组临床资料及sTM、KIM-1水平.对比不同AKI分期患者sTM、KIM-1水平.分析影响PNS患者AKI发生的危险因素.分析sTM、KIM-1及两者联合对PNS所致AKI的诊断效能.结果 两组性别比例、年龄、体质量指数、合并基础疾病、用药史、血红蛋白水平比较,差异均无统计学意义(P＞0.05).AKI组24h尿蛋白、尿酸、胱抑素C、血肌酐、尿素氮水平高于非AKI组(P＜0.05),尿量、白蛋白、肾小球滤过虑低于非AKI组(P＜0.05).AKI组sTM、KIM-1水平高于非AKI组.Ⅲ期和Ⅱ期AKI患者sTM、KIM-1水平高于Ⅰ期(P＜0.05),Ⅲ期患AKI患者sTM、KIM-1水平高于Ⅱ期(P＜0.05).多因素逐步 Logistic 回归分析结果显示:胱抑素 C[(OR)=2.965(95％CI:1.220,7.207)]、eGFR[(OR)=3.340(95％CI:1.374,8.118)]、sTM[(OR)=3.089(95％CI:1.271,7.508)]、KIM-1[(OR)=3.016(95％CI:1.241,7.330)]均为影响PNS患者AKI发生的危险因素(P＜0.05).sTM、KIM-1及两者联合对PNS所致AKI诊断的敏感性分别为 76.47％(95％CI:0.668,0.841)、73.53％(95％CI:0.637,0.816)、71.57％(95％CI:0.616,0.798),特异性分别为 70.67％(95％CI:0.589,0.803)、74.66％(95％CI:0.631,0.837)、96.00％(95％CI:0.880,0.990),曲线下面积分别为 0.754(95％CI:0.684,0.816)、0.783(95％CI:0.717,0.839)、0.891(95％CI:0.841,0.935).结论 sTM、KIM-1两者联合对PNS所致AKI的早期诊断价值较高.
Abstract
Objective To investigate the early diagnostic value of soluble thrombomodulin(sTM)combined with kidney injury molecule-1(KIM-1)for acute kidney injury(AKI)caused by primary nephrotic syndrome(PNS).Methods A total of 177 PNS patients admitted to our hospital from January 2019 to October 2022 were selected and divided into the AKI group(102 cases)and the non-AKI group(75 cases)according to whether AKI occurred.The clinical data and levels of sTM and KIM-1 were compared between the AKI group and the non-AKI group.The levels of sTM and KIM-1 in patients with different AKI stages were also compared.The risk factors for AKI in PNS patients were determined,and the diagnostic performance of sTM and KIM-1 alone and their combination for AKI caused by PNS was analyzed.Results There was no difference in the sex composition,age,BMI,underlying diseases,medication history,and the hemoglobin level between the two groups(P＞0.05).The levels of 24-hour urine protein,uric acid,cystatin C,serum creatinine(Scr),and blood urea nitrogen(BUN)in the AKI group were higher than those in the non-AKI group(P＜0.05),while urine volume,the level of albumin,and estimated glomerular filtration rate(eGFR)in the AKI group were lower than those in the non-AKI group(P＜0.05).The levels of sTM and KIM-1 in the AKI group were higher than those in the non-AKI group.Specifically,the levels of sTM and KIM-1 in patients with stages Ⅲ and Ⅱ AKI were higher than those in patients with stage Ⅰ AKI(P＜0.05),while they were even higher in patients with stage Ⅲ AKI than those in patients with stage Ⅱ AKI(P＜0.05).Multivariable stepwise Logistic regression analysis revealed that high levels of cystatin C[(OR)=2.965(95％CI:1.220,7.207)],eGFR[(OR)=3.340(95％CI:1.374,8.118)],sTM[(OR)=3.089(95％CI:1.271,7.508)],and KIM-1[(OR)=3.016(95％CI:1.241,7.330)]were all risk factors for AKI in PNS patients(P＜0.05).The sensitivities of sTM,KIM-1 and their combination in the diagnosis of AKI caused by PNS were 76.47％(95％CI:66.84％,84.06％),73.53％(95％CI:63.71％,81.55％),and 71.57％(95％CI:61.64％,79.84％),with the specificities being 70.67％(95％CI:58.86％,80.33％),74.66％(95％CI:63.08％,83.69％),and 96.00％(95％CI:87.97％,98.96％),and AUCs being 0.754(95％CI:0.684,0.816),0.783(95％CI:0.717,0.839),and 0.891(95％CI:0.841,0.935).Conclusion The combination of sTM and KIM-1 has a high value in the early diagnosis of AKI caused by PNS.
基金项目
广东省自然科学基金(2021A1515010215)
国家科技期刊平台
NSTL
万方数据