中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (04): 231-234.doi: 10.3969/j.issn.1671-4091.2022.04.002

• 临床研究 • 上一篇    下一篇

Ⅰ型心肾综合征患者血清脑钠肽、胱抑素C、肾损伤分子水平及与急性肾损伤的相关性和预测价值

张松雨1,姚明杨1,周晓铎1   

  1. 1南阳市中心医院心内科
  • 收稿日期:2021-10-13 修回日期:2021-12-16 出版日期:2022-04-12 发布日期:2022-04-07
  • 通讯作者: 张松雨 zhangsongyu1234@sina.com E-mail:fgfgbe@163.com

Serum BNP, CysC, KIM-1 Levels in Patients with Type I CRS and Correlation with AKI and Diagnostic Value

  1.  1Department of Cardiology, Nanyang Central Hospital, Nanyang 473003, China
  • Received:2021-10-13 Revised:2021-12-16 Online:2022-04-12 Published:2022-04-07

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摘要： 【摘要】目的探究Ⅰ型心肾综合征(cardiorenal syndrome，CRS)患者血清脑钠肽(brain natriuretic peptide，BNP)、胱抑素C(cystatin c，CysC)及肾损伤分子(kidney injury molecule-1，KIM-1)水平，与急性肾损伤(acute kidney injury，AKI)的相关性和预测价值。方法选取2017 年3 月～2020年3 月南阳市中心医院收治的急性心力衰竭患者211 例。其中，合并AKI 89 例为观察组，未出现AKI 122例为对照组。根据肾损伤严重程度，将观察组分为轻度组(28 例)，中度组(46 例)，重度组(15 例)3 个亚组。分别检测各组血清BNP、CysC、KIM-1 水平。采用Pearson 相关分析血清BNP、CysC、KIM-1 水平和AKI的相关性。使用受试者工作特征曲线(ROC)评估血清BNP、CysC、KIM-1 对Ⅰ型CRS AKI 的预测价值。结果观察组血清BNP[(1124.36±765.61)ng/L]、CysC[(1.81±0.59)mg/L]及KIM-1[(157.89±16.59)ng/L]水平均高于对照组[(816.56±631.25)ng/L，(0.92±0.08)mg/L，(136.52±13.43)ng/L](t=3.195, 16.470, 10.328, P=0.001, ＜0.001，＜0.001)。观察组中，重度组、中度组血清BNP[(1453.65±668.92)ng/L，(1135.13 ± 459.31)ng/L]、CysC[(2.37 ± 0.63)mg/L，(1.86 ± 0.51)]mg/L 及KIM- 1[(179.86 ±17.12)ng/L，(158.21 ± 15.56)ng/L] 水平与轻度组[(930.26 ± 356.45)ng/L，(1.43 ± 0.46)mg/L，(145.58 ± 14.27)ng/L]，3 组间存在统计学差异(F=1.956，12.546，12.165，P=0.034，0.009，0.011)。Pearson 分析结果显示血清BNP、CysC 及KIM- 1 水平与血清肌酐(Scr) 之间均呈正相关(r=0.713，r=0.727，r=0.715，P 均＜0.001)。ROC 曲线分析结果显示血清BNP 预测Ⅰ型CRS AKI 的AUC 为0.716(95% CI：0.603～0.830，P=0.001)；血清CysC 预测Ⅰ型CRS AKI 的AUC 为0.792(95% CI：0.698～0.897，P＜0.001)；血清KIM-1 预测Ⅰ型CRS AKI 的AUC 为0.749(95% CI：0.641～0.857，P＜0.001)；联合指标预测Ⅰ型CRS AKI 的AUC 为0.880(95% CI：0.804～0.955，P＜0.001)。结论Ⅰ型CRS 患者血清BNP、CysC、KIM-1 水平均升高。血清BNP、CysC、KIM-1 水平均与病情严重程度密切相关，可以作为反映Ⅰ型CRS 病情程度的指标。血清BNP、CysC、KIM-1 联合对Ⅰ型CRS AKI 的预测具有重要的价值。

关键词: Ⅰ型心肾综合征, 急性肾损伤, 脑钠肽, 血清胱抑素C, 肾损伤分子

Abstract: 【Abstract】Objective To investigate the levels of serum brain natriuretic peptide (BNP), serum cystatin C (CysC) and kidney injury molecule (KIM-1) in patients with type I cardiorenal syndrome (CRS), and explore the relationship between these factors and acute kidney injury (AKI). Methods 211 patients with acute heart failure admitted to our hospital between March 2017 and March 2020 were recruited. Among them, 89 patients with AKI were in the observation group, and 122 patients without AKI were in the control
group. According to the severity of kidney injury, the observation group was divided into three subgroups: mild group (n=28), moderate group (n=46), and severe group (n=15). The levels of serum BNP, CysC and KIM-1 were tested in all patients. Pearson correlation analysis was used to analyze the correlation between serum BNP, CysC, KIM-1 levels and AKI. The receiver operating characteristic curve (ROC) was used to evaluate the predictive value of serum BNP, CysC, and KIM- 1 for type I CRS AKI. Results The serum BNP [(1124.36±765.61 ng/L)], CysC [(1.81±0.59 mg/L)] and KIM-1[(157.89±16.59 ng/L)] levels in the observation
group were higher than that in the control group [(816.56±631.25)ng/L, (0.92± 0.08)mg/L, [(136.52±13.43)ng/L] (t=3.195, 16.470, 10.328, P=0.001,＜0.001, ＜0.001)]. In the observation group, the serum BNP(1453.65 ± 668.92)ng/L, (1135.13 ± 459.31)ng/L], CysC [(2.37 ± 0.63)mg/L, (1.86 ± 0.51)mg/L] and KIM- 1[(179.86) ±17.12)ng/L,(158.21±15.56)ng/L] in the severe and moderate subgroups were higher than the mild subgroup [(930.26 ± 356.45)ng/L, (1.43 ± 0.46)mg/L, (145.58 ± 14.27)ng/L], and the serum BNP [(1453.65 ±668.92)ng/L], CysC [(2.37±0.63)mg/L] and KIM-1 [(179.86±17.12)ng/L] levels in the severe subgroup were higher than that in the moderate subgroup [(1135.13±459.31)ng/L, (1.86±0.51)mg/L, (158.21±15.56)ng/L (F=
1.956, 12.546, 12.165, P=0.034, 0.009, 0.011)]. Pearson analysis showed that serum BNP, CysC and KIM-1 levels were positively correlated with serum creatinine (Scr) (r=0.713, r=0.727, r=0.715, P＜0.001). ROC curve analysis showed that the AUC of serum BNP for predictive of type I CRS AKI was 0.716 (95% CI: 0.603 to 0.830, P=0.001); the AUC of serum CysC for predictive of type I CRS AKI was 0.792 (95% CI: 0.698 to 0.897, P＜0.001); the AUC of serum KIM-1 for predictive of type I CRS AKI was 0.749 (95% CI: 0.641～0.857, P＜0.001) ; the AUC of the combined index predictive of type I CRS AKI was 0.880 (95% CI: 0.804～0.955, P＜0.001). Conclusion The serum levels of BNP, CysC and KIM-1 were all increased in patients with type I CRS. Serum BNP, CysC, KIM-1 levels are closely related to the severity of AKI, and can be used as indicators to reflect the severity of type I CRS. The combination of serum BNP, CysC and KIM-1 has important value in the prediction of type I CRS AKI.

Key words: Type I cardiorenal syndrome, Acute kidney injury, Brain natriuretic peptide, Serum cystatin C, Kidney injury molecule

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