急性肾损伤早期诊断的研究进展

Research Progress on Early Diagnosis of Acute Kidney Injury

摘要: 背景：急性肾损伤(Acute Kidney Injury, AKI)是一种由多种病因导致的、以肾功能急剧下降为特征的临床综合征，在住院患者，尤其危重症患者中发病率高，并与其他器官衰竭、住院时间延长及死亡率增加相关。至今还未发现能有效针对AKI的治疗药物，早期、准确地识别AKI高危患者或处于亚临床阶段的AKI，对于及时干预、改善患者预后至关重要。传统诊断AKI主要依赖于血清肌酐(Scr)和尿量的变化，但这些指标存在敏感性不足、特异性不足及滞后性等局限。因此，探寻或验证能更早、更精准地预测AKI发生的新型生物标记物或新方法，已成为当前肾脏疾病研究领域的核心热点之一。目的：本综述旨在系统梳理近期关于预测AKI发生的新型生物标志物或影像学检查的研究进展，关注其在不同高危患者(如脓毒症、心脏手术、肝肾移植等)的预测效能、联合应用价值。方法：对多个数据库进行了深入检索，包括知网、万方、维普、Pubmed和Medline。通过“急性肾损伤”“预测”“生物标志物”“早期诊断”“预警”等关键词，搜索近五年发表的文章，收录涉及人类受试者的原始研究、临床试验、系统评价以及Meta分析，特别关注对急性肾损伤(AKI)的早期诊断有意义的新指标，排除标准包括动物研究或体外研究、病例报告、信件、社论和会议记录，缺乏对新指标详细描述的研究也被排除在外。结果：新型蛋白标记物、炎症及免疫指标、影像学与功能学评估指标、以及多指标联合预测模型等为AKI的早期预测提供了新的临床思路。

Abstract: Background: Acute Kidney Injury (AKI) is a clinical syndrome characterized by a sharp decline in renal function caused by multiple causes. It has a high incidence in hospitalized patients, especially critically ill patients, and is associated with other organ failure, prolonged hospitalization, and increased mortality. So far, no effective therapeutic drug has been found for AKI. Early and accurate identification of patients at high risk of AKI or AKI in the subclinical stage is crucial for timely intervention and improving patient prognosis. Traditional diagnosis of AKI mainly relies on changes in serum creatinine (Scr) and urine output, but these indicators have limitations such as insufficient sensitivity, insufficient specificity and hysteresis. Therefore, exploring or verifying new biomarkers or new methods that can predict the occurrence of AKI earlier and more accurately has become one of the core hot spots in the current field of kidney disease research. Objective: This review aims to systematically review the recent research progress on new biomarkers or imaging examinations for predicting the occurrence of AKI, focusing on their predictive performance and joint application value in different high-risk patients (such as sepsis, cardiac surgery, liver and kidney transplantation, etc.). Methods: An in-depth search was conducted on multiple databases, including CNKI, Wanfang, VIP, Pubmed and Medline. Articles published in the past five years were searched through keywords such as “acute kidney injury”, “prediction”, “biomarker”, “early diagnosis” and “early warning”, and original studies, clinical trials, systematic reviews and meta-analyses involving human subjects were included. Special attention was paid to new indicators that are meaningful for the early diagnosis of acute kidney injury (AKI). The exclusion criteria included animal studies or in vitro studies, case reports, letters, editorials and conference records. Studies that lacked detailed descriptions of new indicators were also excluded. Results: New protein markers, inflammation and immune indicators, imaging and functional evaluation indicators, and multi-index joint prediction models provide new clinical ideas for the early prediction of AKI.