可溶性血栓调节蛋白联合肾损伤分子1对原发性肾病综合征所致急性肾损伤的早期诊断价值

Early diagnostic value of soluble thrombomodulin combined with kidney injury molecule-1 for acute kidney injury caused by primary nephrotic syndrome

摘要:

目的 探讨可溶性血栓调节蛋白（sTM）联合肾损伤分子1（KIM-1）对原发性肾病综合征（PNS）所致急性肾损伤（AKI）的早期诊断价值。方法 选取2019年1月—2022年10月中山市人民医院收治的177例PNS患者，依据是否发生AKI分为AKI组（102例）和非AKI组（75例）。对比两组临床资料及sTM、KIM-1水平。对比不同AKI分期患者sTM、KIM-1水平。分析影响PNS患者AKI发生的危险因素。分析sTM、KIM-1及两者联合对PNS所致AKI的诊断效能。结果 两组性别比例、年龄、体质量指数、合并基础疾病、用药史、血红蛋白水平比较，差异均无统计学意义（P >0.05）。AKI组24 h尿蛋白、尿酸、胱抑素C、血肌酐、尿素氮水平高于非AKI组（P <0.05），尿量、白蛋白、肾小球滤过虑低于非AKI组（P <0.05）。AKI组sTM、KIM-1水平高于非AKI组。Ⅲ期和Ⅱ期AKI患者sTM、KIM-1水平高于Ⅰ期（P <0.05），Ⅲ期患AKI患者sTM、KIM-1水平高于Ⅱ期（P <0.05）。多因素逐步Logistic回归分析结果显示：胱抑素C ［O^R=2.965（95% CI：1.220，7.207）］、eGFR［O^R=3.340（95% CI：1.374，8.118）］、sTM ［O^R=3.089（95% CI：1.271，7.508）］、KIM-1 ［O^R=3.016（95% CI：1.241，7.330）］均为影响PNS患者AKI发生的危险因素（P <0.05）。sTM、KIM-1及两者联合对PNS所致AKI诊断的敏感性分别为76.47%（95% CI：0.668，0.841）、73.53%（95% CI：0.637，0.816）、71.57%（95% CI：0.616，0.798），特异性分别为70.67%（95% CI：0.589，0.803）、74.66%（95% CI：0.631，0.837）、96.00%（95% CI：0.880，0.990），曲线下面积分别为0.754（95% CI：0.684，0.816）、0.783（95% CI：0.717，0.839）、0.891（95% CI：0.841，0.935）。结论 sTM、KIM-1两者联合对PNS所致AKI的早期诊断价值较高。

Abstract:

Objective To investigate the early diagnostic value of soluble thrombomodulin (sTM) combined with kidney injury molecule-1 (KIM-1) for acute kidney injury (AKI) caused by primary nephrotic syndrome (PNS).Methods A total of 177 PNS patients admitted to our hospital from January 2019 to October 2022 were selected and divided into the AKI group (102 cases) and the non-AKI group (75 cases) according to whether AKI occurred. The clinical data and levels of sTM and KIM-1 were compared between the AKI group and the non-AKI group. The levels of sTM and KIM-1 in patients with different AKI stages were also compared. The risk factors for AKI in PNS patients were determined, and the diagnostic performance of sTM and KIM-1 alone and their combination for AKI caused by PNS was analyzed.Results There was no difference in the sex composition, age, BMI, underlying diseases, medication history, and the hemoglobin level between the two groups (P > 0.05). The levels of 24-hour urine protein, uric acid, cystatin C, serum creatinine (Scr), and blood urea nitrogen (BUN) in the AKI group were higher than those in the non-AKI group (P < 0.05), while urine volume, the level of albumin, and estimated glomerular filtration rate (eGFR) in the AKI group were lower than those in the non-AKI group (P < 0.05). The levels of sTM and KIM-1 in the AKI group were higher than those in the non-AKI group. Specifically, the levels of sTM and KIM-1 in patients with stages Ⅲ and Ⅱ AKI were higher than those in patients with stage Ⅰ AKI (P < 0.05), while they were even higher in patients with stage III AKI than those in patients with stage II AKI (P < 0.05). Multivariable stepwise Logistic regression analysis revealed that high levels of cystatin C [O^R = 2.965 (95% CI: 1.220, 7.207) ], eGFR [O^R = 3.340 (95% CI: 1.374, 8.118) ], sTM [O^R = 3.089 (95% CI: 1.271, 7.508) ], and KIM-1 [O^R = 3.016 (95% CI: 1.241, 7.330) ] were all risk factors for AKI in PNS patients (P < 0.05). The sensitivities of sTM, KIM-1 and their combination in the diagnosis of AKI caused by PNS were 76.47% (95% CI: 66.84%, 84.06%), 73.53% (95% CI: 63.71%, 81.55%), and 71.57% (95% CI: 61.64%, 79.84%), with the specificities being 70.67% (95% CI: 58.86%, 80.33%), 74.66% (95% CI: 63.08%, 83.69%), and 96.00% (95% CI: 87.97%, 98.96%), and AUCs being 0.754 (95% CI: 0.684, 0.816), 0.783 (95% CI: 0.717, 0.839), and 0.891 (95% CI: 0.841, 0.935).Conclusion The combination of sTM and KIM-1 has a high value in the early diagnosis of AKI caused by PNS.