【摘要】 目的观察肾损伤分子1(kidney injury molecule-1,KIM-1)在急性肾损伤(acute kidney injury,AKI)患者尿液中的变化,探讨其在AKI早期诊断中的意义。方法收集2008年1月至10月中南大学湘雅医院肾内科及ICU住院的AKI患者、5·12汶川地震伤员、终末期肾脏病(end stage renal disease,ESRD)患者及健康对照者的血清、尿液及临床表现等资料。按照RIFLE标准,将住院治疗患者分为轻度AKI组20例、中重度AKI组25例;另外,地震外伤组25例、ESRD组20例和健康对照组30例;采用ELISA方法检测尿KIM-1,比色法检测尿N-乙酰-β-D-氨基葡萄糖苷酶(N-acetyl-beta-D-glucosaminidase,NAG),黄嘌呤氧化酶法检测血清超氧化物歧化酶(superoxide dismutase,SOD),硫代巴比妥酸比色法检测血清丙二醛(malonaldehyde,MDA);对尿KIM-1与尿NAG、血清SOD及MDA的相关性进行统计学分析,并绘制受试者工作特征曲线(receiver operator characteristic curve,ROC曲线),评价尿KIM-1在AKI早期临床诊断中的价值和意义。结果与健康对照组及ESRD组比较,轻度AKI组和中重度AKI组,尿KIM-1均有明显升高(P<0.05);其中中、重度AKI组较轻度AKI组尿KIM-1升高更明显(P<0.05);尿KIM-1与NAG酶、血清SOD及MDA呈正相关关系;同时尿KIM-1的曲线下面积为0.914(P<0.01)。ESRD组尿KIM-1与健康对照组比较差异无统计学意义(P>0.05)。地震外伤组尿KIM-1较健康对照组升高(P<0.05)。结论AKI发生时,检测尿中KIM-1有助于AKI的早期临床诊断。AKI患者尿中KIM-1升高的主要病理生理机制可能与氧化应激有关。更多还原

【Abstract】 Objectives To investigate the significance of kidney injury molecule-1 (KIM-1) changes in urine in patients with acute kidney injury (AKI).Methods Clinical presentations,and urine and serum samples were collected in patients admitted to Xiangya hospital in January to October 2008 with slight AKI (20 cases),medium-severe AKI (25 cases),wounded individuals by Wenchuan earthquake (25 cases),and end stage renal disease (ESRD,20 cases) based on the RIFLE criteria.Urine and serum samples were also collected from 30 healthy controls.Urinary KIM-1 was assayed by ELISA,urinary N-acetyl-beta-D-glucosaminidase (NAG) by colorimetric method,serum superoxide dismutase (SOD) by xanthine oxidase method,and serum malonaldehyde (NDA) by thiobarbituric acid colorimetric method.The correlation between KIM-1 and NAG in urine was analyzed,and the sensitivity and specificity of urinary KIM-1 in the early diagnosis of AKI were evaluated using the receiver operator characteristic (ROC) curve.Results Urinary KIM-1 increased significantly in patients with slight and medium-severe AKI,as compared with that in ESRD patients and normal controls (P < 0.05).Urinary KIM-1 was higher in patients with medium-severe AKI than in slight AKI (P < 0.05).Urinary KIM-1 was positively correlated with urinary NAG,serum SOD and serum MDA,and it had the area under the ROC of 0.914 (P < 0.01).No statistically significant difference was found in urinary KIM-1 between ESRD patients and healthy controls (P > 0.05).Urinary KIM-1 was higher in wounded individuals by earthquake than in normal controls (P < 0.05).Conclusions Urinary KIM-1 is a useful marker for the early diagnosis of AKI.Higher urinary KIM-1 may relate to the AKI-induced oxidative stress.更多还原