| 摘要: |
| 目的:探讨早期尿生物标志物联合肾绞痛指数对重症监护病房儿童急性肾损伤(AKI)的预测能力。方法:选取肾绞痛并急性肾损伤患儿184例,确定患儿入院当天(Day0)的肾绞痛指数(RAI),由此判断是否对危重患儿第3天(Day3)持续、严重性急性肾损伤的发生具有预测作用(Day3-AKI:KDIGO Stage 2~3);同时研究RAI合并尿生物标志物是否对AKI 的预测具有优化作用。结果:184例患儿入院当天共有60例患儿(32.6%)出现肾绞痛(RAI≥8)。与Day0 非肾绞痛患儿相比,Day0 肾绞痛患儿的机械通气时间更长(P<0.01),器官衰竭时间更长(P<0.01),病死率更高(P<0.01)。Day3 共有15例患儿(9.6%)出
现AKI,其中12例(80.0%)为Day0 肾绞痛患儿。尿中的生物标志物联合RAI可增加AKI预测的特异性和准确率,对Day3-AKI的预测具有明显的改善作用(P<0.01)。尿中性粒细胞明胶酶相关载脂蛋白的纳入可使Day3-AKI的RAI-ROC曲线下面积从0.80(95% CI:0.58,1.00)增加到0.97(95% CI:0.93,1.00)。结论:RAI可作为AKI危重患儿功能学危险分级的一种方法,为新型尿液标志物的测量和改善重度、持续性AKI的预测提供依据。 |
| 关键词: 急性肾损伤 生物标志物 肾绞痛 |
| DOI：10.13407/j.cnki.Jpp.1672-108X.2017.09.002 |
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| 基金项目: |
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| Predictive Value of Early Urinary Biomarkers Combined with Renal Angina Index in Children with Acute Kidney Injury in Intensive Care Unit |
| Chen Haiying, Chen Yan, Qiao Ya, Xi E |
| (Yuyang People's Hospital of Yulin, Yulin Children's Hospital, Shaanxi Yulin 719000, China) |
| Abstract: |
| Objective: To assess the predictive ability of early urinary biomarkers combined with renal angina index(RAI) in children with acute kidney injury (AKI) in intensive care unit. Methods: One hundred and eighty-four children with renal angina and acute kidney injury were selected, the RAI on the day of admission (Day 0) were determined and the predictive effects of continuous and acute kidney injury of the critically ill children on third days (Day 3) were determined (Day 3-AKI: KDIGO Stage 2 to 3). In addition,
we investigated whether RAI combined urine biomarkers could optimize the prediction of AKI. Results: A total of 184 children were included. On admission day, 60 children (32.6%) had renal angina (RAI≥8). Compared with Day 0 children without renal angina, Day 0 children with renal angina had longer time of mechanical ventilation (P<0.01), longer time of organ failure (P<0.01), and a higher fatality rate (P<0.01). On the Day 3, there were 15 children (9.6%) occoured AKI, including 12 children (80.0%) with
Day 0 renal angina. The combination of early urinary biomarkers and RAI in urine could increase the specificity and accuracy of AKI prediction, and improve the prediction of Day 3-AKI (P<0.01). Incorporation of urinary neutrophil gelatinase protein increased the area under the RAI-ROC curve of Day 3-AKI from 0.80 (95% CI: 0.58, 1.00) to 0.97 (95% CI: 0.93, 1.00). Conclusion: RAI can be used as a method of functional risk classification for children with AKI in intensive care unit, and provide a basis for the measurement of new urine markers and for the prediction of severe and persistent AKI. |
| Key words: acute kidney injury biomarkers renal angina |
