尿液L-FABP及KIM-1水平用于HBV相关ACLF患者并发AKI的诊断价值

摘要/Abstract

摘要： 目的探讨尿液肝型脂肪酸结合蛋白(urinary liver fatty acid binding protein,uL-FABP)及尿肾损伤分子1(urinary kidney injury moleculer-1,uKIM-1)对HBV相关ACLF患者并发AKI的临床诊断价值。方法纳入2014年10月至2017年5月住院的HBV相关ACLF患者215例,根据是否发生AKI分为AKI组(n=88)及无AKI组(n=127)。使用ELISA方法检测患者uL-FABP及uKIM-1水平。分析uL-FABP及uKIM-1水平与临床指标的相关性,ROC曲线检测指标的诊断效能。结果 AKI组的uL-FABP及uKIM-1分别为(605.40±276.67) ng/mL、(7.90±2.85) ng/mL,显著高于无AKI组的(298.51±108.71) ng/mg、(2.89±1.09) ng/mg,差异有统计学意义(P<0.01)。AKI组中,uL-FABP及uKIM-1均与WBC、sCr、MELD评分、AKI分期呈显著正相关,与eGFR呈显著负相关。uL-FABP单独诊断ACLF相关AKI的AUC为0.800,uKIM-1的AUC为0.793,uL-FABP联合uKIM-1诊断AKI的AUC为0.836。用于区别诊断严重AKI(AKI-3期)与轻中度AKI(AKI-1及AKI-2期)患者时,uL-FABP的AUC为0.754,uKIM-1的AUC为0.809,uL-FABP联合uKIM-1的AUC为0.813。结论 uL-FABP及uKIM-1单独或联合用于HBV相关ACLF患者并发AKI的临床诊断价值较高。

关键词: 慢加急性肝衰竭, 急性肾损伤, 肝型脂肪酸结合蛋白, 肾损伤分子1, 诊断

Abstract: Objective To investigate the diagnostic value of urinary liver fatty acid binding protein (uL-FABP) and urinary kidney injury moleculer-1 (uKIM-1) in hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) patients with acute kidney injury (AKI). Methods A total of 215 patients with HBV-related ACLF admitted to our hospital from October 2014 to May 2017 were enrolled, which were divided into AKI group (n=88) and non-AKI group (n=127). The uL-FABP and uKIM-1 levels were tested by ELISA. The correlations of uL-FABP and uKIM-1 with clinical parameters were analyzed. Diagnostic values of uL-FABP and uKIM-1 for AKI in patients with HBV-related ACLF were evaluated by receiver operating characteristic (ROC) curve. Results The uL-FABP (605.40±276.67 vs. 298.51±108.71 ng/mg, P<0.001) and uKIM-1 (7.90±2.85 vs. 2.89±1.09 ng/mg, P<0.001) levels in AKI group were both significantly higher than those in non-AKI group. In AKI group, the uL-FABP and uKIM-1 levels were both significantly positively associated with white blood cell count, serum creatinine level, model for end-stage liver disease score and AKI stage, while negatively correlated with estimated glomerular filtration rate. In diagnosis of AKI in patients with ACLF, area under the ROC curve (AUC) of uL-FABP was 0.800, AUC of uKIM-1 was 0.793, and AUC of uL-FABP/uKIM-1 combination was 0.836. To distinguish severe AKI (AKI-3) from mild to moderate AKI (AKI-1 and AKI-2), AUCs of uL-FABP, uKIM-1, and uL-FABP/uKIM-1 combination was 0.754, 0.809, and 0.813, respectively. Conclusion The clinical diagnostic values of uL-FABP and uKIM-1 used alone or in combination in patients with HBV-related ACLF were relatively high.

Key words: Acute-on-chronic liver failure, Acute kidney injury, Liver fatty acid binding protein, Kidney injury moleculer-1, Diagnosis

彭景, 唐怡. 尿液L-FABP及KIM-1水平用于HBV相关ACLF患者并发AKI的诊断价值[J]. 肝脏, 2018, 23(11): 959-963.

PENG Jing, TANG Yi. Research of diagnostic value of urinary L-FABP and KIM-1 levels in HBV-related ACLF patients with AKI[J]. Chinese Hepatolgy, 2018, 23(11): 959-963.

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