尿RBP、L-FABP及血清Presepsin对开颅血肿清除术后并发AKI的预测价值 ?(1)
【摘要】 目的 探討颅脑外伤患者尿视黄醇结合蛋白(RBP)、肝型脂肪酸结合蛋白(L-FABP)、血清可溶性CD14亚型(Presepsin)水平对开颅血肿清除术后并发急性肾损伤(AKI)的预测价值。方法 选取颅脑外伤患者279例，根据术后是否并发AKI将其分为非AKI组(193例)与AKI组(86例);再根据急性肾损伤国际标准(AKIN)分期将AKI组分为Ⅰ期组(27例)、Ⅱ期组(37例)、Ⅲ期组(22例)。比较术后2 ～ 4 h各组尿RBP、L-FABP及血清Presepsin水平;采用受试者工作特征曲线(ROC)评估各指标预测AKI价值。结果 AKI组尿RBP、L-FABP及血清Presepsin水平均高于非AKI组(P均< 0.05)。随AKI分期增加，尿RBP、L-FABP、血清Presepsin水平依次增高(P< 0.05)。RBP、L-FABP、Presepsin预测AKI的曲线下面积(AUC)为0.946、0.990、0.965;预测灵敏度、特异度：RBP 为88.4%、88.6%，L-FABP为98.8%、92.2%，Presepsin为91.9%、89.1%。L-FABP的预测准确性高于RBP、Presepsin(P均< 0.05)。结论 颅脑外伤患者尿RBP、L-FABP及血清Presepsin水平可早期预测开颅血肿清除术后AKI的发生，并可反映肾损伤严重程度。
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【关键词】 颅脑外伤;急性肾损伤;视黄醇结合蛋白;肝型脂肪酸结合蛋白;可溶性CD14亚型
【Abstract】 Objective To investigate the predictive values of urinary retinol-binding protein (RBP)， liver fatty acid binding protein (L-FABP) and serum soluble CD14 subtype (Presepsin) levels for acute kidney injury (AKI) in patients with craniocerebral trauma after craniotomy. Methods A total of 279 patients with craniocerebral trauma who underwent craniotomy for hematoma evacuation were enrolled and divided into the non-AKI group (n = 193) and AKI group (n = 86) according to whether they were complicated with AKI. According to the AKI staging criteria proposed by Acute Kidney Injury Network (AKIN)， patients in the AKI group were further divided into stage Ⅰ (n = 27)， stage Ⅱ (n = 37) and stage Ⅲ groups (n = 22).The urinary RBP， L-FABP and serum Presepsin levels at postoperative 2-4 h were statistically compared among different groups. The predictive value of each parameter for AKI was assessed by the receiver operating characteristic (ROC) curve. Results In the AKI group， urinary RBP， L-FABP and serum Presepsin levels were significantly higher than those in the non-AKI group (all P < 0.05). The levels of three parameters were significantly increased over the AKI staging (all P < 0.05). The areas under the curve (AUC) predicted by RBP， L-FABP and Presepsin were 0.946， 0.990 and 0.965， respectively. The sensitivity and specificity of RBP were 88.4% and 88.6%， 98.8% and 92.2% for L-FABP， 91.9% and 89.1% for Presepsin， respectively. The prediction accuracy of L-FABP was considerably higher than those of RBP and Presepsin (both P < 0.05).Conclusion The urinary RBP， L-FABP and serum Presepsin level in patients with craniocerebral trauma can early predict the incidence of AKI and evaluate the severity of AKI after craniotomy for hematoma evacuation.
【Key words】 Craniocerebral trauma;Acute kidney injury;Retinol-binding protein;, 百拇医药(李锋 杨建树 许大远)
, http://www.100md.com
【关键词】 颅脑外伤;急性肾损伤;视黄醇结合蛋白;肝型脂肪酸结合蛋白;可溶性CD14亚型
【Abstract】 Objective To investigate the predictive values of urinary retinol-binding protein (RBP)， liver fatty acid binding protein (L-FABP) and serum soluble CD14 subtype (Presepsin) levels for acute kidney injury (AKI) in patients with craniocerebral trauma after craniotomy. Methods A total of 279 patients with craniocerebral trauma who underwent craniotomy for hematoma evacuation were enrolled and divided into the non-AKI group (n = 193) and AKI group (n = 86) according to whether they were complicated with AKI. According to the AKI staging criteria proposed by Acute Kidney Injury Network (AKIN)， patients in the AKI group were further divided into stage Ⅰ (n = 27)， stage Ⅱ (n = 37) and stage Ⅲ groups (n = 22).The urinary RBP， L-FABP and serum Presepsin levels at postoperative 2-4 h were statistically compared among different groups. The predictive value of each parameter for AKI was assessed by the receiver operating characteristic (ROC) curve. Results In the AKI group， urinary RBP， L-FABP and serum Presepsin levels were significantly higher than those in the non-AKI group (all P < 0.05). The levels of three parameters were significantly increased over the AKI staging (all P < 0.05). The areas under the curve (AUC) predicted by RBP， L-FABP and Presepsin were 0.946， 0.990 and 0.965， respectively. The sensitivity and specificity of RBP were 88.4% and 88.6%， 98.8% and 92.2% for L-FABP， 91.9% and 89.1% for Presepsin， respectively. The prediction accuracy of L-FABP was considerably higher than those of RBP and Presepsin (both P < 0.05).Conclusion The urinary RBP， L-FABP and serum Presepsin level in patients with craniocerebral trauma can early predict the incidence of AKI and evaluate the severity of AKI after craniotomy for hematoma evacuation.
【Key words】 Craniocerebral trauma;Acute kidney injury;Retinol-binding protein;, 百拇医药(李锋 杨建树 许大远)