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尿肾损伤分子-1对肝硬化合并急性肾损伤患者临床疗效的预测价值

作者：段忠辉任美欣朱学敏

关键词：肝硬化肾功能损伤急性尿肾损伤分子-1 预后

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出版年,卷(期):页码：2017,9(4):63-68

摘要：

摘要：目的探究尿肾损伤分子-1（kidney injury molecule-1，KIM-1）对肝硬化合并急性肾损伤（acute
kidney injury，AKI）患者临床疗效的预测价值。方法选取2014年9月至2017年1月首都医科大学附属
北京佑安医院收治的肾功能正常的肝硬化患者14例为对照组，留取尿标本，采用ELISA方法检测尿
KIM-1水平；选取肝硬化合并新发AKI患者61例为试验组，停用利尿剂、血管扩张剂及肾毒性药物，
并给予静脉滴注白蛋白等扩容治疗48小时，根据治疗后血肌酐（serum creatinine，SCr）改善情况将
肝硬化合并AKI患者分为治疗有效组和治疗无效组，检测患者诊断AKI时和液体扩容治疗48小时后尿
KIM-1水平，分析其对疗效的预测价值。结果 61例肝硬化合并AKI患者扩容治疗有效34例，无效27
例。诊断AKI时，治疗有效组与无效组患者尿KIM-1水平差异无统计学意义（z = -0.784，P = 0.433）；
治疗后，有效组患者尿KIM-1水平低于无效组（z = -4.827，P ＜ 0.001）。诊断AKI时，治疗有效组
患者尿KIM-1水平高于对照组（z = -2.814，P = 0.005）；治疗后，有效组患者尿KIM-1水平较诊断
AKI时下降（z = -3.011，P = 0.003），无效组患者尿KIM-1水平则较诊断AKI时升高（z = -3.437，P =
0.001）。结论肝硬化合并AKI患者尿KIM-1水平升高，扩容治疗无效组尿KIM-1水平高于有效组，且
呈进行性升高。肝硬化合并AKI患者检测尿KIM-1水平有助于预测扩容治疗的疗效。

Abstract: Objective To investigate the predictive value of urinary kidney injury molecule -1 (KIM-1) on clinical
curative effect of liver cirrhosis patients with acute kidney injury (AKI). Methods A total of 61 liver cirrhosis patients
with newly developed AKI in Beijing You’an Hospital, Capital Medical University were selected as experimental
group from September 2009 to January 2017 and 14 liver cirrhosis patients with normal renal function were selected.
Random urinary levels of KIM-1 of patients in control group were assessed by ELISA. For patients in experimental
group, diuretics, vasodilators and medications with nephrotoxicity were discontinued, circulatory volume expansion
therapy and intravenous infusion of albumin were applied for 48 hours. Cirrhosis patients with AKI were divided into
effective group and ineffective group according to the improvement of SCr. Urinary levels of KIM-1 were assessed
by ELISA at the time of diagnosis of AKI and treatment for 48 hours, the predictive value of KIM-1 were analyzed.
Results After circulatory volume expansion therapy, 34 cases were diagnosed as effective and 27 cases were
ineffective. The urinary KIM-1 level when AKI was diagnosed between effective group and ineffective group had
no statistical difference (z = -4.827, P ＜ 0.001). After treatment, urinary KIM-1 level of patients in effective group
was lower than that in ineffective group (z = -4.827, P ＜ 0.001). When diagnosed as AKI, urinary KIM-1 level of
effective group patients was higher than that in control group (z = -2.814, P = 0.005). After treatment, urinary KIM-
1 level of effective group patients was lower than that when AKI was diagnosed (z = -3.011, P = 0.003), which was
higher in ineffective group (z = -3.437, P = 0.001). Conclusion The urinary KIM-1 level increased in liver cirrhosis
patients with AKI. The level of urinary KIM-1 in ineffective group was higher than that in the effective group and
was progressively increased. The urinary KIM-1 level in liver cirrhosis patients with AKI can be used to evaluate the
therapeutic effects.

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