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肝硬化合并急性肾损伤的尿液相关预测因素分析
An analysis of urinary factors for predicting acute kidney injury in patients with liver cirrhosis
文章发布日期:2018年09月30日  来源:  作者:徐曼曼,陈煜  点击次数:250次  下载次数:34次

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【摘要】:目的探讨肝硬化并发急性肾损伤(AKI)的预测因素。方法连续入组2017年5月-2018年4月于首都医科大学附属北京佑安医院就诊的肝硬化失代偿期患者105例,分为AKI组(49例)和非AKI组(56例)。收集患者临床一般资料以及实验室检查结果,留取患者入院时尿液标本,检测尿血管紧张素原(uAGT)、尿中性粒细胞明胶酶相关脂质运载蛋白(uNGAL)、尿肾损伤因子(KIM)1,并以尿肌酐(UCr)校正。正态分布计量资料组间比较采用t检验,非正态分布计量资料组间比较采用Mann-Whitney U检验;计数资料组间比较采用χ2检验,进行logistic多因素分析,绘制受试者工作特征曲线(ROC曲线)评估预测效能。结果与非AKI组比较,AKI组患者合并上消化道出血及自发性腹膜炎的比例较高(χ2值分别为11.420、8.083,P值均<0.05),且白细胞计数、TBil、DBil、尿素氮、SCr均高于非AKI组(Z值分别为-3.401、-2.082、-2.207、-5.872、-7.460,P值均<0.05),血Na低于非AKI组(t=-4.905,P<0.05);AKI组患者的uNGAL/UCr、uKIM-1/UCr高于非AKI组(Z值分别为-7.654、-2.395,P值均<0.05);多因素分析结果显示SCr、血Na、uNGAL/UCr均为肝硬化并发AKI的独立预测因素(P值均<0.05)。ROC曲线分析显示,SCr预测AKI的界值为88.1 μmol/L,其灵敏度93%、特异度82%,ROC曲线下面积(AUC)为0.915[95%可信区间(95%CI):0.850~0980];uNGAL预测AKI的界值为1.62 μg/g,其灵敏度87%、特异度81%,AUC为0.950(95%CI:0.911~0.989);uNGAL联合SCr后预测AKI的AUC为0.964 (95%CI: 0.931~0.998)。结论uNGAL是肝硬化合并AKI的独立危险因素,可用于肝硬化继发AKI的早期诊断,uAGT、uKIM-1不能独立预测肝硬化合并AKI的发生,其应用价值仍有待探索。
【Abstract】:ObjectiveTo investigate the predictive factors for acute kidney injury (AKI) in patients with liver cirrhosis. MethodsA total of 105 patients with decompensated liver cirrhosis who visited Beijing YouAn Hospital from May 2017 to April 2018 were enrolled. These patients were divided into AKI group (n=49) and non-AKI group (n=56). Their general information and laboratory results were collected, and urine samples were collected on admission to measure urinary angiotensinogen (AGT), urinary neutrophil gelatinase-associated lipocalin (NGAL), and urinary kidney injury molecule-1 (KIM-1), which were corrected for urinary creatinine (UCr). The t test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data; the chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was performed. The receiver operating characteristic (ROC) curve was plotted to evaluate predictive efficiency. ResultsCompared with the non-AKI group, the AKI group had significantly higher proportions of patients with upper gastrointestinal bleeding and spontaneous bacterial peritonitis (χ2=11.420 and 8.083, both P<0.05), significantly higher levels of leukocyte count, total bilirubin, direct bilirubin, urea nitrogen, and serum creatinine (SCr) (Z=-3.401, -2.082, -2.207, -5.872, and -7.460, all P<0.05), and a significantly lower level of blood sodium (t=-4.905, P<0.05). The AKI group had significantly higher urinary NGAL/UCr and urinary KIM-1/UCr than the non-AKI group (Z=-7.654 and -2.395, both P<0.05). The multivariate analysis showed that SCr, blood sodium, and urinary NGAL/UCr were independent predictive factors for AKI in patients with liver cirrhosis (all P<0.05). The ROC curve analysis showed that at the cut-off value of 88.1 μmol/L, SCr had a sensitivity of 93%, a specificity of 82%, and an area under the ROC curve (AUC) of 0.915 (95% confidence interval [CI]: 0.850-0.980) in predicting AKI; at the cut-off value of 1.62 μg/g, urinary NGAL had a sensitivity of 87%, a specificity of 81%, and an AUC of 0.950 (95% CI: 0.911-0.989) in predicting AKI; urinary NGAL combined with SCr had an AUC of 0.964 (95% CI: 0.931-0.998). ConclusionUrinary NGAL is an independent risk factor for AKI in patients with liver cirrhosis and can be used for the early diagnosis of AKI in these patients. Urinary AGT and KIM-1 cannot independently predict the development of AKI in liver cirrhosis, and their application value awaits further exploration.
【关键字】:肝硬化; 肾功能不全, 急性; 危险因素
【Key words】:liver cirrhosis; renal insufficiency, acute; risk factors
【引证本文】:XU MM, CHEN Y. Predictive factors for acute kidney injury in patients with liver cirrhosis[J]. J Clin Hepatol, 2018, 34(10): 2124-2129. (in Chinese)
徐曼曼, 陈煜. 肝硬化合并急性肾损伤的尿液相关预测因素分析[J]. 临床肝胆病杂志, 2018, 34(10): 2124-2129.

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