血清胰岛素样生长因子结合蛋白-7水平对乙型肝炎肝硬化并发急性肾损伤患者的诊断价值

摘要/Abstract

摘要： 目的评估血清胰岛素样生长因子结合蛋白-7(IGFBP-7)水平对乙型肝炎肝硬化并发急性肾损伤患者的诊断价值。方法将2018年1月至2023年1月在苏州市中西医结合医院接受治疗的132例乙型肝炎肝硬化患者纳入研究,将发生急性肾损伤的患者设为观察组(n=40),未发生急性肾损伤的患者为对照组(n=92)。收集两组患者的基本资料,包括性别、年龄、病因、基础疾病等。采集患者入组72 h内的血液和尿液样本,测定血清中总胆红素(TBil)、肌酐(Scr)、血尿素氮(BUN)、胱抑素(CysC)、β2-微球蛋白(β2-MG)水平,并分别检测血清和尿液中的IGFBP-7水平。采用logistic回归分析筛选乙型肝炎肝硬化患者并发急性肾损伤的风险因素,并通过ROC曲线评估血清和尿液中IGFBP-7水平对急性肾损伤的诊断价值。结果观察组患者血清中TBil、Scr、BUN、CysC、β2-MG、IGFBP-7水平分别为(40.03 ± 6.32)μmol/L、(110.42 ± 23.36)μmol/L、(14.53 ± 3.23)mmol/L、(1.57 ± 0.42)mg/L、(2.77 ± 0.46)mg/L、(12.12 ± 3.76)μg/L,尿液IGFBP-7水平为(28.09 ± 4.52)μg/L,均高于对照组(均P＜0.05)。多因素分析结果表明,Scr、BUN、CysC、IGFBP-7水平越高,患者发生急性肾损伤的风险越高(P＜0.05)。ROC曲线显示,血清IGFBP-7评估乙型肝炎肝硬化患者并发急性肾损伤的AUC值为0.857,与尿液中的IGFBP-7水平联合检测的AUC值为0.978。结论血清IGFBP-7水平的升高与乙型肝炎肝硬化患者发生急性肾损伤密切相关,且血清和尿液中IGFBP-7水平的联合检测有更高的诊断准确度。

关键词: 胰岛素样生长因子结合蛋白-7, 乙型肝炎, 肝硬化, 急性肾损伤, 诊断效能

Abstract: Objective To evaluate the diagnostic value of serum insulin-like growth factor binding protein-7 (IGFBP-7) levels in patients with hepatitis B-related cirrhosis complicated by acute kidney injury (AKI). Methods The study included 132 patients with hepatitis B-related cirrhosis treated in Suzhou Integrated Traditional Chinese and Western Medicine Hospital from January 2018 to January 2023. Patients who developed AKI were assigned to the observation group (n=40), while those without AKI constituted the control group (n=92). Basic data including gender, age, etiology and underlying diseases were collected from both groups of patients. Blood and urine samples were collected within 72 hours of enrollment to measure serum levels of total bilirubin (TBil), creatinine (Scr), blood urea nitrogen (BUN), cystatin C (CysC), and β2-microglobulin (β2-MG), as well as IGFBP-7 levels in both serum and urine. Logistic regression analysis was used to identify risk factors for AKI in patients with hepatitis B-related cirrhosis, and the diagnostic value of IGFBP-7 levels in serum and urine for assessing AKI was evaluated using Receiver operating characteristic (ROC) curve method. Results In the observation group, the levels of serum TBil, Scr, BUN, CysC, β2-MG, and IGFBP-7 were respectively 40.03 ± 6.32 μmol/L, 110.42 ± 23.36 μmol/L, 14.53 ± 3.23 mmol/L, 1.57 ± 0.42 mg/L, 2.77 ± 0.46 mg/L, and 12.12 ± 3.76 μg/L. The level of IGFBP-7 in urine was 28.09 ± 4.52 μg/L, all of which were higher than those in the control group (P< 0.05). Multifactorial analysis indicated that higher levels of Scr, BUN, CysC, and IGFBP-7 are associated with an increased risk of acute kidney injury (AKI) in patients (P<0.05). The ROC curve analysis revealed that the accuracy of serum IGFBP-7 in assessing the risk of AKI in patients with hepatitis B virus-induced cirrhosis was 0.857, which increased to 0.978 when combined with the measurement of urinary IGFBP-7 levels. Conclusion Elevated serum IGFBP-7 levels are closely related to the occurrence of AKI in patients with hepatitis B-related cirrhosis, and combined measurement of serum and urine IGFBP-7 levels provides higher diagnostic accuracy.

Key words: Insulin-like growth factor binding protein-7, Hepatitis B, Cirrhosis, Acute kidney injury, Diagnostic efficacy

马肖敏, 蒋叶舟, 陈国飞. 血清胰岛素样生长因子结合蛋白-7水平对乙型肝炎肝硬化并发急性肾损伤患者的诊断价值[J]. 肝脏, 2025, 30(8): 1061-1065.

MA Xiao-min, JIANG Ye-zhou, CHEN Guo-fei. The diagnostic value of serum insulin-like growth factor binding protein-7 levels in patients with hepatitis B-related cirrhosis complicated with acute kidney injury[J]. Chinese Hepatolgy, 2025, 30(8): 1061-1065.

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