肾阻力指数联合uNGAL、CysC对急性胰腺炎肾损伤的预测价值

Predictive Value of Renal Resistance Index Combined with uNGAL and CysC on Renal Injury in Acute Pancreatitis

摘要: 目的：探讨肾阻力指数(RRI)、尿中性粒细胞明胶酶相关脂蛋白(uNGAL)、胱抑素C (CysC)对急性胰腺炎(AP)患者急性肾损伤(AKI)的早期预测价值。方法：分析63例AP患者的临床资料，根据入院7天内是否发生AKI分成两组：AKI组(24例)和非AKI组(39例)。测量两组患者入院24小时内RRI、uNGAL、CysC水平，绘制受试者工作特征曲线(ROC)，计算曲线下面积(AUC)，评价三个指标对AP并发AKI的早期预测价值，并比较RRI联合uNGAL或CysC的预测价值。结果：AKI组RRI、uNGAL、CysC、乳酸、急性生理学及慢性健康状况评分系统(APACHE-II)评分及序贯器官衰竭估计(SOFA)评分高于非AKI组(P < 0.05)。RRI、uNGAL、CysC预测AP患者发生急性肾损伤的曲线下面积(AUC)分别为0.860、0.815、0.652，对应最佳临界值分别为0.71、63.02 ng/ml、0.74 mg/L，RRI和uNGAL的预测价值均优于CysC (P < 0.05)，RRI和uNGA联合应用时AUC为0.909，高于单一RRI或uNGAL的预测价值(P < 0.05)。对AKI组分析显示，RRI、uNGAL以及二者联合应用预测AP发生AKI的患者需行肾替代治疗的AUC分别为0.878、0.785、0.941，二者联合应用优于单一RRI或uNGAL的预测价值(P < 0.05)。结论：RRI联合uNGAL对AP患者发生AKI具有较高的预测价值。

Abstract: Objective: To investigate the early predictive value of renal resistance index (RRI), urinary neutro-phil gelatinase associated lipoprotein (uNGAL) and cystatin C (CysC) on acute renal injury (AKI) in patients with acute pancreatitis (AP). Methods: The clinical data of 63 patients with AP were ana-lyzed. According to whether AKI occurred within 7 days after admission, they were divided into two groups: AKI group (24 cases) and non AKI group (39 cases). The levels of RRI, uNGAL and CysC in the two groups were measured within 24 hours after admission, the receiver operating characteris-tic curve (ROC) was drawn, the area under the curve (AUC) was calculated, the early predictive val-ue of the three indicators for AP complicated with AKI was evaluated, and the predictive value of RRI combined with uNGAL or CysC was compared. Results: The scores of RRI, uNGAL, CysC, lactate, APACHE-II and SOFA in AKI group were higher than those in non AKI group (P < 0.05). The areas under the curve (AUC) of RRI, uNGAL and CysC in predicting acute renal injury in AP patients were 0.860, 0.815 and 0.652 respectively, and the corresponding critical values were 0.71, 63.02 ng/ml and 0.74 mg/l respectively. The predictive value of RRI and uNGAL was better than CysC (P < 0.05). The AUC of RRI and uNGAL was 0.909, which was higher than that of single RRI or uNGAL (P < 0.05). The analysis of AKI group showed that the AUCs of RRI, uNGAL and their combination in predicting AKI in AP patients were 0.878, 0.785 and 0.941 respectively. The predictive value of RRI, uNGAL and their combination was better than that of single RRI or uNGAL (P < 0.05). Conclusion: RRI com-bined with uNGAL has high predictive value for AKI in patients with AP.