新型生物学标志物在肝硬化AKI早期诊断和鉴别诊断中的研究进展

摘要/Abstract

摘要： 急性肾功能损伤是肝硬化(失代偿期)住院患者的常见并发症,最常见的类型是肾前性氮质血症、肝肾综合征和急性肾小管坏死。国际腹水俱乐部新发布的指南将肝硬化急性肾损伤的诊断标准更改为基于血肌酐值的动态变化,这提高了诊断敏感性,但对肝肾综合征和急性肾小管坏死的鉴别诊断却较为困难,两者对扩容治疗都不敏感,病情都可能在短期内迅速进展。本文对有望用于肝硬化急性肾损伤早期诊断或鉴别病因的6种新型生物学标志物做一综述。

张云, 尹伟, 郭洪雷, 李成忠. 新型生物学标志物在肝硬化AKI早期诊断和鉴别诊断中的研究进展[J]. 肝脏, 2021, 26(9): 953-955.

参考文献

[1] Desai AP, Knapp SM, Orman ES, et al. Changing epidemiology and outcomes of acute kidney injury in hospitalized patients with cirrhosis-a US population-based study. J Hepatol, 2020, 73:1092-1099.
[2] Francoz C. Acute kidney injury in cirrhosis: An immediate threat but also a ticking time bomb. J Hepatol, 2020, 72:1043-1045.
[3] 尹伟, 李成忠. 肝硬化急性肾损伤发病风险和治疗应答影响因素的前瞻性研究. 肝脏,2020,25:791-796.
[4] Treeprasertsuk S, Wongkarnjana A, Jaruvongvanich V, et al. Urine neutrophil gelatinase-associated lipocalin: a diagnostic and prognostic marker for acute kidney injury (AKI) in hospitalized cirrhotic patients with AKI-prone conditions. BMC Gastroenterol,2015,15:140.
[5] Garcia-Tsao G, Parikh CR, Viola A. Acute kidney injury in cirrhosis. Hepatology, 2008,48:2064-2077.
[6] Puthumana J, Ariza X, Belcher JM, et al. Urine Interleukin 18 and Lipocalin 2 Are Biomarkers of Acute Tubular Necrosis in Patients With Cirrhosis: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol,2017,15:1003-1013.
[7] Huelin P, Solà E, Elia C, et al. Neutrophil Gelatinase-Associated Lipocalin for Assessment of Acute Kidney Injury in Cirrhosis: A Prospective Study. Hepatology, 2019,70:319-333.
[8] Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care,2007,11:R31.
[9] Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract,2012,120:c179-c184.
[10] Angeli P, Gines P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. Gut,2015,64:531-537.
[11] Belcher JM, Sanyal AJ, Peixoto AJ, et al. Kidney biomarkers and differential diagnosis of patients with cirrhosis and acute kidney injury. Hepatology, 2014,60:622-632.
[12] Fagundes C, Pépin MN, Guevara M, et al. Urinary neutrophil gelatinase-associated lipocalin as biomarker in the differential diagnosis of impairment of kidney function in cirrhosis. J Hepatol, 2012, 57:267-273.
[13] Salerno F, Gerbes A, Ginès P, Wong F, Arroyo V. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Postgrad Med J,2008,84:662-670.
[14] 庞国菊, 武玉晶, 刘爽, 等. 肝硬化继发急性肾损伤患者血清胱抑素C和中性粒细胞明胶酶相关脂质运载蛋白的水平及其诊断价值. 中华肝脏病杂志,2019:65-67.
[15] 尹伟, 李成忠. 基于NGAL的模型在肝硬化急性肾损伤早期诊断和鉴别诊断中的意义. 肝脏,2021,26:247-251.
[16] Jaques DA, Spahr L, Berra G, et al. Biomarkers for acute kidney injury in decompensated cirrhosis: A prospective study. Nephrology (Carlton),2019,24:170-180
[17] 康晓征, 赵勇, 乐磊, 等. 肝型脂肪酸结合蛋白对比白介素18对肝硬化失代偿期急性肾损伤患者的诊断价值. 安徽医科大学学报,2018,53:1289-1293.
[18] Yin C, Wang N. Kidney injury molecule-1 in kidney disease. Ren Fail,2016,38:1567-1573.
[19] Moresco RN, Bochi GV, Stein CS, De Carvalho JAM, Cembranel BM, Bollick YS. Urinary kidney injury molecule-1 in renal disease. Clin Chim Acta,2018,487:15-21.
[20] Shao X, Tian L, Xu W, et al. Diagnostic value of urinary kidney injury molecule 1 for acute kidney injury: a meta-analysis. PLoS One,2014,9:e84131.
[21] 姚梁, 张培珠, 钟金成. 血液及尿液中CysC、KIM-1、NGAL水平在肝硬化继发急性肾功能损伤患者中的诊断价值. 中国急救复苏与灾害医学杂志,2021,16:68-71.
[22] Yap DY, Seto WK, Fung J, et al. Serum and urinary biomarkers that predict hepatorenal syndrome in patients with advanced cirrhosis. Dig Liver Dis,2017,49:202-206.
[23] 杨俊伟, 张靖华, 韩健乐. L-FABP联合IL-18检测在肝硬化失代偿期急性肾损伤中的诊断价值. 中国校医,2020,34:445-446.
[24] 袁剑峰, 张翠芳, 苏振宏. 胰岛素样生长因子结合蛋白7在肝硬化患者急性肾损伤时的诊断价值. 皖南医学院学报, 2018,37:233-236.
[25] 韩焕钦, 欧进军, 冯冰, 等. 尿IGFBP7及TIMP-2在失代偿期乙型肝炎肝硬化急性肾损伤中的应用价值. 中华肝脏病杂志,2020,28:760-765.
[26] 李明, 陈入溧, 吴振平, 等. 尿液中IGFBP7和TIMP-2联合检测对HBV相关慢加急性肝衰竭致急性肾损伤的预测价值. 临床肝胆病杂志,2019,35:1560-1564.
[27] Simonetto DA, Gines P, Kamath PS. Hepatorenal syndrome: pathophysiology, diagnosis, and management. BMJ,2020, 370:m2687.
[28] Allegretti AS, Ortiz G, Wenger J, et al. Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort Study. Int J Nephrol, 2015, 2015:108139.
[29] Xiong J, Pu L, Xiong H, et al. Evaluation of the criteria of hepatorenal syndrome type of acute kidney injury in patients with cirrhosis admitted to ICU. Scand J Gastroenterol,2018,53:1590-1596.
[30] Ostermann M, Zarbock A, Goldstein S, et al. Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference: A Consensus Statement. JAMA Netw Open,2020,3:e2019209.
[31] Bell M, Larsson A, Venge P, et al.. Assessment of cell-cycle arrest biomarkers to predict early and delayed acute kidney injury. Dis Markers,2015, 2015:158658.
[32] Lei L, Li LP, Zeng Z, et al. Value of urinary KIM-1 and NGAL combined with serum Cys C for predicting acute kidney injury secondary to decompensated cirrhosis. Sci Rep, 2018, 8:7962.