|
摘要：
目的 探讨尿细胞周期停滞标志物——金属蛋白酶组织抑制剂‑2（tissue inhibitor of metalloproteinase‑2, TIMP‑2）和胰岛素样生长因子结合蛋白‑7（insulin‑like growth factor binding protein‑7, IGFBP‑7）对老年患者腔镜腹部大手术后急性肾损伤（acute kidney injury, AKI）的预测价值。 方法 选取2021年5月至2021年12月在徐州医科大学附属医院择期全麻下行腹腔镜胃及结直肠手术的老年患者，依据诊断标准分为AKI组（12例）和非AKI组（123例）。收集患者围手术期相关资料。术后6~12 h内收集新鲜尿液标本，采用ELISA法测定尿液中TIMP‑2及IGFBP‑7浓度，并计算二者乘积［TIMP‑2×IGFBP‑7］。采用受试者工作特征（receiver operating characteristic, ROC）曲线分析TIMP‑2、IGFBP‑7以及［TIMP‑2×IGFBP‑7］对术后AKI的预测价值。 结果 最终共纳入135例患者，其中12例术后发生AKI，123例未发生AKI，AKI总体发生率为8.89%。AKI组患者年龄、ASA分级Ⅲ级的比例、年龄校正的查尔森合并症指数（age‑adjusted Chalson comorbidity index, aCCI）≥4的比例、基线胱抑素C、基线血糖值等均高于非AKI组（P<0.05），AKI组患者ASA分级Ⅱ级的比例低于非AKI组（P<0.05）。AKI组患者的术中乳酸水平，TIMP‑2、IGFBP‑7浓度，［TIMP‑2×IGFBP‑7］，术后入ICU比例，术后30 d内病死率等均高于非AKI组（P<0.05）。对术后AKI的预测价值，TIMP‑2的ROC曲线下面积（area under the curve, AUC）为0.689，95%CI 0.603~0.766（P=0.010），敏感度为91.67%，特异性为44.72%，截断值为5.765 μg/L；IGFBP‑7的ROC AUC为0.774，95%CI 0.694~0.842（P<0.001），敏感度和特异性分别为83.33%、65.85%，截断值为12.043 μg/L；［TIMP‑2×IGFBP‑7］的ROC AUC为0.813，95%CI 0.737~0.875（P<0.001），敏感度和特异性分别为66.67%、86.99%，截断值为0.094 （μg/L）2/1 000。 结论 尿液TIMP‑2及IGFBP‑7对老年患者腔镜腹部大手术后AKI具有良好的预测价值，两者联合预测价值更高。
|
|
Abstract: Objective To explore the predictive value of urinary cell cycle arrest biomarkers‑‑tissue inhibitor of metalloproteinase‑2 (TIMP‑2) and insulin‑like growth factor binding protein‑7 (IGFBP‑7) for acute kidney injury (AKI) in elderly patients undergoing laparoscopic major abdominal surgery. Methods Elderly patients who underwent elective laparoscopic gastric and colorectal surgery under general anesthesia in the Affiliated Hospital of Xuzhou Medical University from May 2021 to December 2021 were enrolled. According to diagnostic criteria, they were divided into two groups: an AKI group (n=12) and a non‑AKI group (n=123). Their perioperative data were collected, while fresh urinary samples were collected within 6‒12 h after surgery. The concentrations of urine TIMP‑2 and IGFBP‑7 were measured by enzyme‑linked immunosorbent assay (ELISA) and the product of [TIMP‑2×IGFBP‑7] was calculated. A receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of TIMP‑2, IGFBP‑7 and [TIMP‑2×IGFBP‑7] for postoperative AKI. Results A total of 135 patients were included in the current study. Postoperative AKI occurred in 12 patients, while no AKI was reported in 123 patients, with an overall AKI incidence of 8.89%. The AKI group showed increases in age, the percentage of American Society of Anesthesiologists (ASA) Ⅲ, the percentage of age‑adjusted Chalson comorbidity index (aCCI)≥4, baseline cystatin C and baseline blood glucose, compared with the non‑AKI group (P<0.05). The AKI group presented a lower percentage of ASA Ⅱ than the non‑AKI group (P<0.05). Compared with the non‑AKI group, increases were found in intraoperative lactate, TIMP‑2 and IGFBP‑7 concentrations, [TIMP‑2×IGFBP‑7], the proportion of patients admitted to intensive care unit (ICU) after surgery and postoperative mortality within 30 days in the AKI group (P<0.05). Furthermore, the area under the curve (AUC) of TIMP‑2 was 0.689 [(95%CI 0.603, 0.766), P=0.010], with a sensitivity of 91.67%, a specificity of 44.72%, and the cut‑off value of 5.765 μg/L. The AUC of IGFBP‑7 was 0.774 [(95%CI 0.694, 0.842), P<0.001], with a sensitivity of 83.33%, a specificity of 65.85%, and the cut‑off value of 12.043 μg/L. The AUC of [TIMP‑2×IGFBP‑7] was 0.813 [(95%CI 0.737, 0.875), P<0.001], with a sensitivity of 66.67%, a specificity of 86.99%, and the cut‑off value of 0.094 (μg/L)2/1 000. Conclusion Urinary TIMP‑2 and IGFBP‑7 have good predictive vale for AKI after laparoscopic major abdominal surgery in elderly patients, and the combined predictive value is better.
|
