多项生物学标志物联合检测对...并急性肾损伤早期的诊断价值_杨云飞.pdf

安 徽 医 药 Anhui Medical and Pharmaceutical Journal 2023 Jul，27（7）cancer J.J BUON，2020，25（1）：227-239.15SHEN WJ，CUI MM，WANG X，et al.Reduced mean platelet volume is associated with poor prognosis in esophageal cancerJ.Cancer Biomark，2018，22（3）：559-56316QIAN WH，GE XX，WU J，et al.Prognostic evaluation of resectable colorectal cancer using platelet-associated indicators J.Oncol Lett，2019，18（1）：571-580.17ZHANG YI，LIU N，LIU CX，et al.High fibrinogen and platelets correlate with poor survival in gastric cancer patients J.Ann Clin Lab Sci，2020，50（4）：457-462.18ZHANG F，WANG Y，SUN P，et al.Fibrinogen promotes malignant biological tumor behavior involving epithelialmesenchymal transition via the p-AKT/p-mTOR pathway in esophageal squamous cell carcinomaJ.J Cancer Res Clin Oncol，2017，143（12）：2413-2424.19FALANGA A，MARCHETTI M.Hemostatic biomarkers in cancer progression J.Thromb Res，2018，164 Suppl 1：S54-S61.20TAS F，KILIC L，SERILMEZ M，et al.Clinical and prognostic significance of coagulation assays in lung cancerJ.Respir Med，2013，107（3）：451-457.21LI XH，WANG XP，GU WS，et al.Clinical significance of preoperative thrombin time in patients with esophageal squamous cell carcinoma following surgical resection J/OL.PLoS One，2015，10（10）：e0140323.DOI：10.1371/journal.pone.0140323.（收稿日期：2022-04-08，修回日期：2022-05-10）引用本文：杨云飞，王爱田，赵华灵，等.多项生物学标志物联合检测对老年重症病人合并急性肾损伤早期的诊断价值 J.安徽医药，2023，27（7）：1408-1412.DOI：10.3969/j.issn.1009-6469.2023.07.030.多项生物学标志物联合检测对老年重症病人合并急性肾损伤早期的诊断价值杨云飞，王爱田，赵华灵，付珊珊，张建军，梁静涛，李晓岚作者单位：开滦总医院重症医学科，河北 唐山063000通信作者：李晓岚，女，主任医师，研究方向为重症医学科，Email：基金项目：2022年度河北省医学科研课题计划（20221584）摘要：目的 探究多项生物学标志物联合检测在老年重症病人合并急性肾损伤（AKI）早期诊断中的价值。方法 选取2020年5月至2021年6月开滦总医院收治的150例老年重症病人作为研究对象，根据AKI发生与否分为AKI组（n=56）与非AKI组（n=94）。比较两组临床资料、入住ICU即刻、4 h、12 h、24 h尿 金属蛋白酶阻滞抑制剂-2（TIMP-2）胰岛素样生长因子结合蛋白-7（IGFBP7），分析不同时间点 TIMP-2 IGFBP-7 与重症病人AKI及预后不良的关系，绘制受试者操作特征曲线（ROC曲线），评价不同时间点 TIMP-2 IGFBP-7 对重症病人AKI的诊断价值。结果 AKI组年龄、高血压、APACHE评分、血乳酸、肌酐、降钙素原、谷丙转氨酶、动脉血氧分压、动脉血二氧化碳分压与非AKI组比较，差异有统计学意义（P0.05）；AKI组ICU 4 h、12 h、24 h尿 TIMP-2 IGFBP-7 分别为（0.450.08）、（0.680.17）、（0.890.27）、（1.130.32）（g/L）2均高于非AKI组（0.430.07）、（0.500.14）、（0.540.18）、（0.750.21）（g/L）2（P0.05）；logistic回归方程调整年龄、高血压、APACHE评分、血乳酸、肌酐、降钙素原、谷丙转氨酶、动脉血氧分压、动脉血二氧化碳分压等其他混杂因素后，结果显示，ICU4 h、12 h、24 h尿TIMP-2 IGFBP-7 均为重症病人AKI发生独立危险因素（P0.05）；绘制不同时间点 TIMP-2 IGFBP-7 对重症病人AKI诊断价值的ROC曲线，结果显示ICU 4 h、12 h、24 h尿 TIMP-2 IGFBP-7 对重症病人AKI诊断价值的曲线下面积（AUC）分别为0.778、0.830、0.875；Cox单因素、多因素分析均显示ICU 4 h、12 h、24 h尿 TIMP-2 IGFBP-7 与重症病人预后不良有关（P0.05）。结论 老年重症病人入住ICU后4 h、12 h、24 h尿 TIMP-2 IGFBP-7 水平对AKI具有早期评估价值，可作为AKI早期预警、诊断指标，值得临床推广与应用。关键词：危重病；急性肾损伤；金属蛋白酶阻滞抑制剂-2；胰岛素样生长因子结合蛋白-7；重症监护病房Value of combined detection of multiple biomarkers in the early diagnosis of acute kidney injury in elderly critically ill patientsYANG Yunfei,WANG Aitian,ZHAO Hualing,FU Shanshan,ZHANG Jianjun,LIANG Jingtao,LI XiaolanAuthor Affiliation:Department of Intensive Care Medicine,Kailuan General Hospital,Tangshan,Hebei 063000,ChinaAbstract：Objective To explore the value of combined detection of multiple biomarkers in the early diagnosis of acute kidney injury(AKI)in elderly critically ill patients.Methods One hundred and fifty elderly critically ill patients admitted to Kailuan General 临床医学1408安 徽 医 药 Anhui Medical and Pharmaceutical Journal 2023 Jul，27（7）Hospital from May 2020 to June 2021 were selected as the research subjects.According to the occurrence of AKI,they were divided into AKI group(n=56)and non-AKI group(n=94).The clinical data and immediately after admission to ICU,4 h,12 h,24 h urine metalloproteinase blocker-2(TIMP-2)insulin-like growth factor binding protein-7(IGFBP7)value of the two groups were compared.The relationship between TIMP-2IGFBP-7 value at different time points and AKI and poor prognosis in severe patients was analyzed,receiver operating characteristic(ROC)curve was drawn,and the diagnostic value of different time points TIMP-2IGFBP-7 in severe patients with AKI was evaluated.Results The differences in age,hypertension,APACHE score,blood lactic acid,creatinine,procalcitonin,alanine aminotransferase,arterial partial pressure of oxygen,arterial partial pressure of carbon dioxide between the AKI group and the non-AKI group were statistically significant(P0.05).The urine TIMP-2IGFBP-7 values at 4 h,12 h,24 h in ICU of AKI group were(0.450.08)(g/L)2,(0.680.17)(g/L)2,(0.890.27)(g/L)2,and(1.130.32)(g/L)2,respectively,which were higher than those of the non AKI group(0.430.07)(g/L)2,(0.500.14)(g/L)2,(0.540.18)(g/L)2,and(0.750.21)(g/L)2(P0.05).Logistic regression equation showed that after adjusting other confounding factors such as age,hypertension,APACHE score,blood lactate,creatinine,procalcitonin,alanine transaminase,arterial oxygen partial pressure and arterial blood carbon dioxide partial pressure,the urine TIMP-2IGFBP-7 value at 4 h,12 h,24 h in ICU were independent risk factors for AKI in critically ill patients(P0.05);ROC curves of the diagnostic value of urine TIMP-2IGFBP-7 value at different time points for AKI in critically ill patients were drawn.The results s