NGAL、L-FABP和KIM-1对竹叶青蛇和烙铁头蛇伤所致AKI的早期诊断与预后作用

发布时间：2018-05-24 09:54

本文选题：竹叶青蛇 + 烙铁头蛇　；参考：《福建中医药大学》2016年硕士论文

【摘要】：目的：探讨中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肝型脂肪酸结合蛋白(L-FABP)和肾损伤分子-1(KIM-1)对血循毒蛇咬伤所致急性肾损伤(AKI)早期诊断及预后的作用,进一步推进蛇伤的防治及AKI早期诊断的研究工作。方法：病例来源为2015年1月至2015年12月本院急诊科留观病房及蛇伤科住院病房并符合纳入和排除标准的毒蛇咬伤患者。通过全自动生化分析仪检测患者蛇伤后24小时、48小时、72小时、7天和10天的血清肌酐(sCr)、血尿素氮(BUN)和尿酸(UA)水平变化,选用2004年急性透析质量倡议(ADQI)工作组提出的RIFLE分级诊断标准,将病例归为蛇伤AKI组和非AKI组进行队列观察。酶联免疫吸附试验(ELISA)检测患者入院时收集的尿液中NGAL、L-FABP和KIM-1水平,比较其组间差异性,再用ROC曲线分析三者的诊断特性,并行Logistic回归分析,明确三者对蛇伤AKI患者死亡率的影响。结果：最后纳入观察的对象达49例,涉及蛇种包括烙铁头蛇和竹叶青蛇,其例数分别达23和26。蛇伤AKI组例数为24,其sCr变化符合2004年ADQI工作组提出的RIFLE分级诊断标准,分级属风险期或损伤期,个别病例可达衰竭期。非AKI组例数为25。两组的BUN和UA虽部分有差异,但都在正常参考值范围内波动。24例发生AKI的蛇伤患者中有2名病情危重,虽然予积极转移至重症病房进一步行肾替代及其他综合治疗,但最终都在伤后72小时内死亡,而未发生AKI者,死亡人数为0,均痊愈出院,两组死亡率差异无统计学意义(P0.05)。蛇伤AKI组的尿NGAL (uNGAL)、尿L-FABP (uL-FABP)和尿KIM-1 (uKIM-1)水平较非AKI组升高,差异具有统计学意义(P0.01),但三者在不同蛇种所致AKI患者间进行比较后未发现显著差异(P0.05)。通过ROC曲线分析可见,uNGAL、uKIM-1和uL-FABP的ROC曲线下面积(AUC-ROC)均0.7(P0.01)。uL-FABP的AUC-ROC最大(0.952),其最佳诊断界值为27.5ng/ml,各项诊断性评价指标结果均位于三者中的中位。经过Logistic回归分析,发现NGAL、L-FABP和KIM-1与蛇伤AKI患者死亡率的Logistic回归方程的总体检验存在统计学意义(P0.05),但分别针对上述各标志物回归系数进行检验时未发现统计学意义(P0.05)。结论：尿液中NGAL、L-FABP和KIM-1的含量可作为竹叶青蛇和烙铁头蛇伤所致AKI早期诊断的标志物,其中L-FABP诊断能力最优秀。但三者对蛇伤AKI患者的预后作用尚待进一步证实。
[Abstract]:Objective: to investigate the early diagnosis and prognosis of neutrophil gelatinase-associated lipid carrier protein NGALL (L-FABP) and renal injury molecule (-1) KIM-1 in acute renal injury induced by blood-borne snake bite. To further promote the prevention and treatment of snake injury and the early diagnosis of AKI. Methods: from January 2015 to December 2015, the patients in the emergency department and the serpentine department in our hospital met the criteria of inclusion and exclusion of venomous snake bite. The serum creatinine (Cr), blood urea nitrogen (bun) and uric acid (UAA) levels were measured by automatic biochemical analyzer at 24 hours, 48 hours, 72 hours, 7 days and 10 days after snake injury. The RIFLE grading diagnostic criteria proposed by the AHD quality Initiative (ADQI) working group in 2004 were used to classify the cases into snake wound AKI group and non-AKI group for cohort observation. Elisa was used to detect the levels of NGALL-FABP and KIM-1 in urine collected from patients at admission, and to compare their differences. The diagnostic characteristics of the three groups were analyzed by ROC curve, and Logistic regression analysis was performed to determine the effect of the three on the mortality of AKI patients with snake injury. Results: 49 cases were included in the study. The number of snake species involved were 23 and 26, respectively. The number of patients with snake injury in AKI group was 24. The change of sCr was in accordance with the diagnostic criteria of RIFLE classification proposed by ADQI working group in 2004. The classification was a risk period or injury stage, and individual cases could reach the stage of exhaustion. The number of non-AKI cases was 25. Although there were some differences in BUN and UA between the two groups, two of the 24 snake injury patients with AKI were in critical condition, although they were actively transferred to the intensive care unit for further renal replacement and other comprehensive treatment. However, all of them died within 72 hours after injury, but no AKI occurred, the number of deaths was 0, all of them were cured and discharged. There was no significant difference in mortality between the two groups (P 0.05). The levels of urinary NGAL uNGALP, urinary L-FABP uL-FABPand urinary KIM-1 uKIM-1) in snake injury AKI group were higher than those in non-AKI group, and the difference was statistically significant (P 0.01), but no significant difference was found among the patients with AKI caused by different serpent species. From the analysis of ROC curve, we can see that the area under ROC curve of uL-FABP and ROC curve of uL-FABP are the AUC-ROC maximum of 0.7(P0.01).uL-FABP 0.952, and the best diagnostic limit is 27.5 ng / ml. The results of each diagnostic evaluation index are all in the median of the three. By Logistic regression analysis, it was found that the overall test of Logistic regression equation between NGALL-FABP and KIM-1 and AKI patients with snake injury had statistical significance (P 0.05), but no statistical significance was found when the regression coefficients of the above markers were tested. Conclusion: the levels of NGALL-FABP and KIM-1 in urine can be used as markers for the early diagnosis of AKI caused by Bamboo leaf green snake and Tiantou snake wound, among which L-FABP is the best in diagnosis. However, the prognostic effects of these three factors on AKI patients with snake injury need to be further confirmed.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R646

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