论文部分内容阅读
目的探讨尿胱抑素C(Cys C)和尿白细胞介素-18(IL-18)对危重新生儿急性肾损伤(AKI)的早期预测价值。方法选择2010年9月至2011年2月生后6 h内入住本院新生儿重症监护病房的新生儿为研究对象进行前瞻性研究,根据入院1周内是否发生AKI,分为AKI组和非AKI组(对照组)。检测患儿入院当日尿Cys C、IL-18、微量白蛋白(MA)、α1微球蛋白(α1-MG)水平,并于入院24 h内进行新生儿急性生理学评分(SNAP)。以多因素Logistic回归分析评估在校正混杂因素后尿Cys C、IL-18与AKI的关系,用受试者工作特征(ROC)曲线及曲线下面积(AUC)评价尿Cys C、IL-18对新生儿AKI的预测价值。结果研究期间共纳入57例新生儿,11例(19.3%)在入院1周内发生AKI。AKI组出生体重、胎龄、Apagr评分均低于对照组,尿Cys C、IL-18、α1-MG、MA水平及SNAP评分均高于对照组,差异有统计学意义(P<0.05)。Logistic回归分析显示,在校正胎龄、出生体重、尿MA、α1-MG水平及SNAP评分等因素后,尿Cys C、IL-18浓度与AKI显著相关。尿Cys C和IL-18预测新生儿AKI的AUC值分别为0.91(95%CI 0.82~0.99,P<0.001)和0.74(95%CI 0.53~0.95,P=0.015)。结论尿Cys C、IL-18是新生儿AKI的独立预测指标,尿Cys C具有更好的早期预测价值。
Objective To investigate the early predictive value of Cys C and IL-18 in acute neonatal renal injury (AKI). Methods From September 2010 to February 2011, newborns admitted to our neonatal intensive care unit within 6 hours after birth were prospectively studied. According to whether AKI occurred within one week after admission, patients were divided into two groups: AKI group and non-AKI group AKI group (control group). The levels of urine Cys C, IL-18, MA and α1-MG were detected on the day of hospital admission, and the neonatal acute physiology score (SNAP) was measured within 24 hours after admission. Multivariate logistic regression analysis was used to evaluate the relationship between urinary Cys C, IL-18 and AKI after adjusting for confounding factors. Urine Cys C and IL-18 levels were assessed by receiver operating characteristic (ROC) curve and area under the curve (AUC) The predictive value of neonatal AKI. Results A total of 57 newborns were enrolled during the study, and 11 (19.3%) developed AKI within 1 week of admission. The birth weight, gestational age and Apagr score of AKI group were lower than those of control group. The levels of Cys C, IL-18, α1-MG, MA and SNAP were higher in AKI group than those in control group (P <0.05). Logistic regression analysis showed that urine Cys C, IL-18 concentrations were significantly correlated with AKI after adjusting for gestational age, birth weight, urine MA, α1-MG levels and SNAP scores. The AUC values of urinary Cys C and IL-18 in neonates with AKI were 0.91 (95% CI 0.82-0.99, P <0.001) and 0.74 (95% CI 0.53-0.95, P = 0.015), respectively. Conclusions Urinary Cys C and IL-18 are independent predictors of neonatal AKI. Urinary Cys C has better early predictive value.