血清ADM与尿TXB2对肝硬化失代偿期患者肾损伤的诊断效能研究

摘要/Abstract

摘要： 目的: 探讨血清肾上腺髓质素(ADM)与尿血栓素B2(TXB2)对肝硬化失代偿期患者急性肾损伤(AKI)的诊断效能。方法: 选取2016年1月至2019年6月在湖北医药学院附属东风医院收治的肝硬化失代偿期患者78例,分为非AKI组(38例)和AKI组(40例),比较两组患者一般临床资料及血清ADM与尿TXB2含量,分析ADM和TXB2与其他临床指标的相关性,用Logistic回归分析肝硬化失代偿期患者并发AKI的危险因素,用受试者工作特征(ROC)曲线评估ADM和TXB2诊断的效能。结果: 非AKI组与AKI组患者间年龄、性别(男女)、病程、Child-Pugh分级(A/B/C级)和MELD评分(5-6分/7-9分/≥10分)间差异无统计学意义[(51.2±8.6)岁对(54.1±7.6)岁,21/17对26/14,(6.71±1.49)年对(6.42±0.84)年,10/13/15对3/16/21,8/12/18对10/13/17](P>0.05);AKI组患者的白蛋白含量低于非AKI组[(26.95±4.68)g/L对(35.21±6.72)g/L](P<0.05),AKI组患者的尿素氮、总胆红素、Scr、ADM和TXB2含量高于非AKI组[(14.35±2.09)mmol/L对(5.93±0.61)mmol/L,(47.19±2.44)μmol/L对(25.94±3.60)μmol/L,(125.38±14.37)μmol/L对(72.84±4.84)μmol/L,(328.24±45.06)pg/mL对(176.29±24.35)pg/mL,(1885.40±243.51)pg/mL对(1107.69±104.24)pg/mL](P<0.05)。血清中ADM含量与白蛋白呈负相关(r=-0.753,P<0.05),与尿素氮、总胆红素和Scr呈正相关(r=0.851、0.492、0.695,P<0.05);尿TXB2含量与白蛋白呈负相关(r=-0.516,P<0.05),与尿素氮、总胆红素和Scr呈正相关(r=0.641、0.430、0.510,P<0.05)。Scr、ADM和TXB2对肝硬化失代偿期合并AKI具有诊断价值(OR=2.357、95%CI:1.247-4.457,OR=3.458、95%CI:1.195-10.004,OR=3.315、95%CI:2.175-5.052)(P<0.05)。Scr、ADM和TXB2诊断肝硬化失代偿期合并AKI的ROC曲线下面积分别为0.757、0.905和0.880,ADM诊断的灵敏度和特异度均最高,分别为85.16%和87.19%。结论: 肝硬化失代偿期合并AKI患者血清ADM与尿TXB2含量较未合并AKI患者高,检测其含量有助于早期诊断肝硬化失代偿期患者是否并发AKI,值得临床推广。

关键词: 血清肾上腺髓质素, 尿血栓素B2, 肝硬化失代偿期, 肾损伤

Abstract: Objective To investigate the diagnostic efficacies of serum adrenomedullin (ADM) and urinary thromboxane B2 (TXB2) in decompensated cirrhosis patients complicated with acute renal injury (ARI). Methods 78 patients with decompensated cirrhosis admitted to Dongfeng Hospital affiliated to Hubei University of Medicine from January 2016 to December 2018 were enrolled in this study. They were divided into non-AKI group (38 cases) and AKI group (40 cases). The general clinical data and the serum ADM, serum creatinine (Scr), and urinary TXB2 levels between these two groups were compared. The correlation between ADM and TXB2 and other clinical indicators were analyzed. The risk factors of AKI in decompensated cirrhosis patients were analyzed by logistic regression. The ROC curve was used to evaluate the diagnostic efficacies of ADM and TXB2. Results There was no difference in age [(51.19±8.62) years vs (54.06±7.57) years], gender (male/female, 21/17 vs 26/14), course of disease [(6.71±1.49) years vs (6.42±0.84) years], child Pugh grade (A/B/C grade, 10/13/15 vs 3/16/21) and MELD score (5-6/7-9/ ≥10, 8/12/18 vs 10/13/17) between non AKI group and AKI Group (P>0.05). The albumin content in AKI group was lower than that in non-AKI group [(26.95±4.68)g/L vs (35.21±6.72)g/L] (P<0.05). The contents of urea nitrogen [(14.35±2.09) mmol/L vs (5.93±0.61) mmol/L], total bilirubin [(47.19±2.44) μmol/L vs (25.94±3.60)μmol/L], Scr[(125.38±14.37)μmol/L vs (72.84±4.84)μmol/L], ADM [(328.24±45.06)pg/mL vs (176.29±24.35)pg/mL], and TXB2 [(1885.40±243.51)pg/mL vs (1107.69±104.24)pg/mL] in AKI group were higher than those in non-AKI group (P<0.05). The ADM content in serum was negatively correlated with albumin (r=-0.753, P<0.05), whereas positively correlated with urea nitrogen, total bilirubin and Scr (r=0.851, 0.492, 0.695, respectively, P<0.05). The TXB2 content in urine was negatively correlated with albumin (r=-0.516, P<0.05), whereas positively correlated with urea nitrogen, total bilirubin and Scr (r=0.641, 0.430, 0.510, respectively, P<0.05). Scr (OR=2.357, 95%CI:1.247-4.457), ADM (OR=3.458, 95%CI:1.195-10.004) and urine TXB2 (OR=3.315, 95%CI:2.175-5.052) had certain value for the diagnosis of decompensated cirrhosis complicated with AKI (P<0.05). The area under ROC curve (AUC) of Scr, ADM and TXB2 in the diagnosis of decompensated cirrhosis with AKI was 0.757, 0.905 and 0.880, respectively. The sensitivity and specificity of ADM were the highest ( 85.16% and 87.19%, respectively). Conclusion The levels of serum ADM and urinary TXB2 in patients with decompensated cirrhosis complicated with AKI are higher than those in patients without AKI. Detecting serum ADM and urinary TXB2 levels is helpful for early diagnosis of AKI in patients with decompensated cirrhosis, which is worth of widely clinical application.

Key words: Serum adrenomedullin, Urine thromboxane B2, Decompensated liver cirrhosis, Acute renal injury

刘潇, 胡燕, 孙艳君. 血清ADM与尿TXB2对肝硬化失代偿期患者肾损伤的诊断效能研究[J]. 肝脏, 2020, 25(7): 709-713.

LIU Xiao, HU Yan, SUN Yan-jun. Diagnostic efficacies of serum adrenomedullin and urinary thromboxane B2 in patients with decompensated cirrhosis complicated with acute renal injury[J]. Chinese Hepatolgy, 2020, 25(7): 709-713.

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