ALR在急性肾损伤早期诊断中的价值评估和临床意义

发布时间：2018-04-02 05:29

本文选题：肝再生增强因子　切入点：急性肾损伤　出处：《重庆医科大学》2017年硕士论文

【摘要】：目的:急性肾损伤(acute kidney injury,AKI)是一种临床危重症。AKI发病率高、死亡率高,同时也是慢性肾脏病的重要危险因素,长期以来严重威胁着人们的生命健康。及早诊治AKI对于疾病的预后十分重要。急性肾损伤概念的提出,使我们能够在肾小球滤过率(glomerular filtration rate,GFR)开始下降甚至尚正常期,或仅有组织学、生物学指标改变时,能够及早明确诊断、尽早干预AKI。我们在前期动物实验中发现肝再生增强因子(augmenter of liver regeneration,ALR)在AKI大鼠模型肾组织中肾小管表达明显增加,并且随着AKI的病程呈现动态变化。本研究拟探索ALR是否可作为急性肾损伤的早期诊断标志物。方法:将2014年10月至2015年10月在我院ICU住院有发展成急性肾损伤可能的患者64例(平均年龄47±8.3;男34例,女30例)收集入组,观察72小时,并按照KDIGO指南将患者分为AKI组及非AKI组,检测入组后0h、6h、12h、24h、48h和72h患者的血肌酐及血、尿ALR。采用受试者工作特征曲线(receiver operating characteristic curve,ROC)及曲线下面积(Area under curve,AUC)评价ALR诊断AKI的诊断效能。结果:所有患者中,其中40名患者最终发展成急性肾损伤。将急性肾损伤组入组后6h、12h、24h、48h、72h的血ALR浓度与非急性肾损伤组相比,两组在以上各时间点均有统计学差异(P0.05);血ALR浓度于入组后即升高迅速,于入组后12h达到峰值,入组后12小时血ALR的灵敏度和特异度分别为0.975和0.958,AUC为0.993(95%CI:0.977,1);将急性肾损伤组入组后6h、12h、24h、48h的尿ALR浓度与非急性肾损伤组相比,两组在以上各时间点均有统计学差异(P0.05),尿ALR浓度于入组后同样较快升高,于入组后24小时达到峰值,入组后24小时尿ALR的灵敏度和特异度分别为0.975和0.917,AUC为0.984(95%CI:0.96,1)。将急性肾损伤组入组后12h、24h、48h、72h的血肌酐浓度与非急性肾损伤组相比,两组在以上各时间点均有统计学差异(P0.05);血肌酐于入组后72小时仍缓慢进行性升高,入组后72小时灵敏度和特异度分别为0.95和0.792,AUC为0.878(95%CI:0.772,0.984)。结论:血、尿ALR水平在急性肾损伤早期就明显上升,提示ALR有可能是一种急性肾损伤的新型标志物。
[Abstract]:Objective: acute kidney injury (AKI) is an important risk factor for chronic kidney disease. The early diagnosis and treatment of AKI is very important for the prognosis of the disease. The concept of acute renal injury has enabled us to begin to decline or even normal at glomerular filtration rate (glomerular filtration rate). We found that augmenter of liver regeneration and ALR (augmenter of liver regeneration) increased the expression of renal tubules in renal tissue of AKI rats. The purpose of this study was to explore whether ALR can be used as an early diagnostic marker for acute renal injury. Methods: from October 2014 to October 2015, the patients hospitalized in our hospital from October 2014 to October 2015 developed acute renal injury. 64 patients (mean age 47 卤8.3; male 34). According to the KDIGO guidelines, the patients were divided into AKI group and non-#en2# group. The serum creatinine and blood were detected at 0 h, 6 h, 12 h, 24 h, 48 h and 72 h, respectively. Urine ALR. The diagnostic efficacy of ALR in diagnosis of AKI was evaluated by receiver operating characteristic curveover (AUC) and area under curveAUC under the curve. Results: in all patients, The serum ALR concentration in the acute renal injury group was significantly higher than that in the non-acute renal injury group at 12 h, 24 h, 48 h and 72 h, respectively, and the serum ALR concentration increased rapidly at the above time points, P0.05G and P0.05% respectively, compared with that in the non-acute renal injury group (P < 0.05), and no significant difference was found between the two groups (P < 0.05), and there was a significant difference between the two groups at all the above time points (P < 0.05). The sensitivity and specificity of serum ALR were 0.975 and 0.958 at 12 hours after admission, respectively. The urine ALR concentration of acute renal injury group was compared with that of non-acute renal injury group at 6 h, 12 h, 24 h and 48 h after acute renal injury, and the sensitivity and specificity of serum ALR were 0.975 and 0.958 h, respectively. There was statistical difference between the two groups at all the above time points (P 0.05). The urine ALR concentration also increased rapidly after entering the group, and reached the peak at 24 hours after entering the group. The sensitivity and specificity of urinary ALR in 24 hours were 0.975 and 0.917 AUC, respectively. The serum creatinine concentration in acute renal injury group was compared with that in non-acute renal injury group. There were significant differences between the two groups at the above time points (P 0.05), and creatinine increased slowly and progressively at 72 hours after admission, the sensitivity and specificity of creatinine were 0.95 and 0.792 AUC 0.7895 CI: 0.772U 0.9840.Conclusion: blood, Urinary ALR level increased significantly at the early stage of acute renal injury, suggesting that ALR may be a new marker of acute renal injury.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5

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